For young patients with stable fractures, we use the Spine Jack ® (Vexim) reexpansion and cementation system.
Generally, the anesthesia we perform is sedation and local anesthesia. The patient's position on the operating table is prone (face down). After locating the fracture using X-rays, we made two very small incisions on the back, about 5 mm. We locate the pedicles of the fractured vertebra and create a transpedicular access route to insert 2 implants that re-expand the fracture through a system similar to a carjacking. Under X-ray control, we raise the implants and, once the initial shape and height of the fractured vertebra are restored, it is stabilized using bone cement that hardens in a few minutes. To finish, we remove the instruments and put a stitch in each incision.
In the case of patients with stable osteoporotic or osteopenic vertebral fractures, we use balloon kyphoplasty (Kyphon® Medtronic) and cementation for the restoration of the vertebra.
We perform this operation with local anesthesia and sedation in the prone position (face down). The approach is similar to the previous procedure, minimally invasive, with 5mm incisions in the back, at the affected level. In this case, instead of an elevation implant, we use a re-expandable balloon inside the body of the vertebra to restore the subsidence. The entire procedure is performed under X-ray control, and we finish the fracture repair by supporting it with bone cement. Finally, we close both incisions with a stitch.
These techniques make it possible to take a bone sample for its anatomopathological study in the case of suspected pathological fractures due to tumors or bone metabolism diseases.
For unstable fractures with a risk of neurological involvement compressing the spinal cord or nerve roots, with great involvement of the vertebra and its ligaments, a more rigid fixation system is required to stabilize the fracture until it heals, requiring screw fixation and bars.
We use a minimally invasive percutaneous system (CD Horizon Longitude® Medtronic), which reduces muscle damage and only requires small incisions at the vertebral levels that need to be treated to form a stable system.
It is performed under general anesthesia in the prone position (face down). We locate the vertebral levels that require fixation with screws and rods using X-rays and approach with small skin incisions of approximately 1 cm. With constant X-ray vision in two planes, we identify the exact place through which a 1-mm needle is going to be inserted inside the vertebral body through the pedicles of the vertebrae. These will serve as a guide for inserting the cannulated screws.
On the other hand, we introduce the bar into the screws also percutaneously through two small incisions. Using a distraction system, we reduce the fracture and close the small skin incisions with 2 stitches each.