Percutaneous pedicle screw for unstable spine fractures in polytraumatized patients: A report of two cases
A 58-year-old man was involved in a motor vehicle accident whereby his car rammed into a tree. On arrival to the casualty department, the patient was confused and his Glasgow Coma Scale was 12/15. His vital signs were stable with a respiratory rate of 16/min, heart rate of 95/min, and a blood pressure of 126/70 mmHg. There was marked tenderness over the abdomen with guarding and rigidity and he was diagnosed to have an intraabdominal injury. Computed tomography showed pneumoperitoneum, multiple facial bone fracture, left hemopneumothorax and a L2 bony Chance fracture with no neurological deficit. Computed tomography of the brain was normal. An emergency laparotomy was performed 16 hours post trauma. Small bowel resection and anastomosis were performed. Intraoperative findings were small bowel perforation 45 cm from ileocecal junction with contused small bowel mesentery and transverse colon. Following the laparotomy, percutaneous pedicle screw stabilization was performed in prone position. The operative time was 35 min, with a blood loss of less than 100 ml. The total number of image intensifier exposures was 30 at 75–90 kV peak and 1.6–2.2 mA. Intraoperatively, the patient was transfused 2 units of packed red cells with a documented hemoglobin level of 11 g/dL post transfusion. No hemodynamic instability or hypoxia episodes occured intraoperatively. Postoperatively, there were no complications and the patient was allowed to sit up 2 days after the operative procedure.