Author/Authors :
Landi، Alessandro نويسنده Department of Neurology and Psychiatry, Division of
Neurosurgery, Sapienza University of Rome, Italy , , Marotta، Nicola نويسنده Department of Neurology and Psychiatry, Division of
Neurosurgery, Sapienza University of Rome, Italy , , Mancarella، Cristina نويسنده Department of Neurology and Psychiatry, Division of
Neurosurgery, Sapienza University of Rome, Italy , , Colistra، Davide نويسنده Department of Neurology and Psychiatry, Division of
Neurosurgery, Sapienza University of Rome, Italy , , Delfini، Roberto نويسنده Department of Neurology and Psychiatry, Division of
Neurosurgery, Sapienza University of Rome, Italy ,
Abstract :
Introduction Minimally invasive percutaneous surgery of the spine
is used to treat thoracolumbar junction and lumbar spine fractures by
percutaneous fixation. Once fusion has been obtained, it is possible to
remove the percutaneous instrumentation after 6 - 12 months. We report
the case of an obliged removal of the fixation system at 12 months
following operation in a patient with a pre-existing compensated and
asymptomatic idiopathic scoliosis. Case Presentation A 48-year-old
patient affected by a compensated asymptomatic idiopathic scoliosis with
an L3 type A3 fracture. The patient underwent a percutaneous short
fixation L2 - L4. In the following months the patient presented
progressive worsening of the low back pain and walking difficulties. The
percutaneous fixation system was then removed using the same surgical
access. Conclusions This particular case explains well the importance of
biomechanical balance when a spinal fixation should be perform, and
demonstrate how an underestimation of this aspect may cause a worsening
of symptoms even if the surgical procedure was correctly performed. It
is evident that the removal procedure can lead clinical benefit to a
patient, in which the fixation system created a decompensation of the
curvature of the spine, thus causing biomechanical alterations and
generating pain. In these cases, it may be opportune to limit the
fracture reduction during the surgical procedure to modify the least
possible the pre-existing scoliosis and to increase the patient’s
comfort after the operation. The biomechanical behaviour of the spine is
specific for each patient so only a careful detection of it could lead
to an optimal therapeutic result.
