tannoury t fractures

8/7/2019 Tannoury T Fractures

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MIS options for

Spinal Trauma

Assistant Professor, Department of

Orthopedics, Boston University

Chief of Spine, Boston University

Founding President, Society forProgress & Innovations for the Near East

Interest: MIS, Deformity, Tumors

Designs: Viper, Lateral Cougar cage

Medical education exchange: national and

international

Enjoys Tennis, Ski, Travel, Social

Networking

Contact: www.neareastspine.org

Tony Tannoury, MD
http://www.neareastspine.org/http://www.neareastspine.org/


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TONY Y. TANNOURY, MDAssistant Professor,

Department of orthopedicBoston University

MIS options for Spinal Trauma

Disclosure:

Consultant to Depuy,Johnson & Johnson Co

Receive Royalty on some

products that are shown inthis talk

This study was not fundednor supported by Depuy


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Burst fractures

Operative Indications


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Technique

Patient: prone position: hyper-extension

Radiolucent table

Include the fracture level

All percutaneous fixations

All short segment One level above One level below

for NON Fusion group:PlannedROH:4-8 ms po


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ENTRY POINT


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MID-PEDICLE


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NCJUNCTION


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Treatment optionsconsiderations

Can you patient gothrough a long fusionprocedure

Can you patienttolerate a brace


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Surgical options:

Posterior fusion

Anterior fusion

Anterior/posteriorfusion

other


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Fractures evaluation

A

B

C ThoracoLumbar Injury Classification System: TLICS:

TL point system that assists in clinical decision making

Morphology of injury (1-4 points) Integrity of the PLC (0-3 points) Neurological status (0-3 points)

Operative (>5pts) versus Nonoperative approach(


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Treatment recommendations

BRACING SURGERY


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BRACINGSURGERY

Treatment recommendations

complexities

0

10

20

30

40

5060

70

80

Rx Morbidit

Openfusion

bracing


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42 YO fell off three story building

Plateau Fracture

Rx options: Bracing or Cast?

Knee fusion?

Other: ORIF!!!!


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Rx options

Casting/bracing?

External fixation

Knee fusion?

Other???


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Pilon Fracture


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Treatment options

ORIF

EXTERNALFIXATION


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Study design:

Retrospective review Consecutive 53 cases Unstable spinal column

fractures

Neurology: intact or complete: non

fusion Incomplete:

decompression and fusion

Outcome measures: Pain Score Complications Fracture reduction

Initial final


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GOAL: traumatic conditions

To look at our experiencein trauma patientpopulation

Less than optimal condition

Anatomy is often distorted

Need for somemanipulation/reduction

Fragile patients: may or may

not tolerate our spinalprocedure


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45 yo s/p fall

severe right LE weakness

L2

L1

L1


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Final X-rays


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42 yo S/P MCASevere lung contusionleft femur and pelvis fx


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6 mos PO


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After removal of hardware.

NO FUSION


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3 mos post op


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67 yo. Fall of a height. NV Intact


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Post op.


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Time will judge


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22 yo teacher/model


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Post op


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4 months post op


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Post removal of hardware


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18 YO lady. s/p 20 ft height fall

Neurology: intact


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3 COLUMN INJURY

L4 L4


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INTRA-OP Myelogram


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Post op


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Post reduction


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2 mos post op


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2 weeks post op


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POST ROH


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48 yo male, s/p fall

severe right leg weakness


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options

Bracing

Anterior

Posterior Anterior and posterior


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Post op: percutaneous reduction

NO FUSION


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6 months post op


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4 mos post ROH


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Pelvic vertical shear instability

Ili L b bili i


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Iliac Lumbar stabilizationTemporary


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3 moths post op.


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Study design:

Retrospective review

Consecutive 38 cases

Unstable spinal

column fractures Neurology: intact or

complete

Outcome measures:

Pain Score Complications

Fracture reduction Initial

final

CRPF OF THORACOLUMBAR FRACTURES WITH


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CRPF OF THORACOLUMBAR FRACTURES WITHAND WITHOUT FUSION: SAFETY AND OUTCOME

CPRF BURSTFRACTURES

Fractures with Fusion

Internal stabilzation# PATIENTS/#Screws 38/201 15/96

# CT SCANS/#screws 26/131 11/50

# BREACHES 10 (5C, 5NC) 0

AVG BLOOD LOSS 66 ml 355ml

Average F/U 21 Months 21 months

AVG TANSFUSION 170 ml 450 cc

COMPLICATIONS one None

INFECTION - o

PLANNED ROH 31 0

KYPHOSISCORRECTION: pre-tx

and post-tx avg

14.4to 1.8 17 to 5

Unplanned Reopreation one 0

VAS 1.8 3.2


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Discussion

Complications: comparable to open

Reduction: reliable

Infection: much lower


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conclusion

Percutaneous screwfixation is an effectivemethod in treatment ofUnstable spinal fractures

Safe

Able to reproduce desiredstability and sagittalbalance

Conclusion


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Conclusion

Open Surgery

Criminal

C l i


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Conclusion:Advantages of MIS Rx

No fusion is agreat option


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FUSION?

tannoury t fractures

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