Percutaneous pedicle screw for unstable spine fractures in polytraumatized patients: A report of two cases
A 32-year-old man presented to us following a fall from height. He suffered from left posterior 4th to 12th rib fracture with subcutaneous emphysema, lung contusion and bilateral hemopneumothorax, intraabdominal injury with pneumoperitoneum, left renal injury (grade 3) with perinephric hematoma, and a T11 bony Chance fracture without neurological deficit. At the casualty department, bilateral chest tubes were inserted. At presentation, the patient was tachypneic with a respiratory rate of 26/min, blood pressure was 124/88 mmHg with a heart rate between 125 and 136 beats/min. He was resuscitated with fluids. An initial hemoglobin level of 9.5 g/dL was documented.\nThe patient underwent an emergency laparotomy with small bowel resection and end-to-end anastomosis at 13 hours posttrauma. Following this, minimally invasive percutaneous instrumentation from T10 to T12 was done. Four percutaneous screws were inserted simultaneously through four stab incisions []. The instrumentation was performed using size 5.5 mm screws for both T10 as well as T12 vertebrae. The duration of the operation was 45 min, with a blood loss of 75 mls (measured by soaked gauze). The screws were inserted simultaneously to reduce the amount of image intensifier exposures required for the procedure. The total exposure (Siemens Siremobil 2000) was 25 exposures at 75–90 kV peak and 1.5–2.0 mA. Intraoperatively, 2 units of packed red blood cells were transfused. Intraoperative hemoglobin was maintained at 10.0 g/dL. No hemodynamic instability or hypoxic episodes were documented intraoperatively.\nPostoperatively, the patient was allowed to turn to his side every two hourly and was also allowed to be propped up on day 1. On postoperative day 3, once the abdominal and chest drains were removed, the patient was allowed to sit up and stand independently. Subsequently, a thoracolumbar support orthosis was applied and the patient was discharged on day 15 post injury.