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Thoracolumbar TraumaMIS Options

Hyeun Sung Kim, MD, PhD,Ji Soo Jang, MD, PhD, Jung Hoon Choi, MD, Sung Kyun Jung MD, Jung Sub Lee, MD

Department of Neurosurgery, Nanoori Hospital, Suwon City, South Korea

Medical College of Chosun University , Gwangju, South Korea (1994) / Board of Neurosurgery (1999)

MEMBERSHIPS & PROFESSIONAL SOCIETIES

Korean Neurosurgical Society / Korean Spinal Neurosurgery Society / Korean Minimal Invasive Spine Surgery Society / Korean Society of Peripheral

Nervous System / Korean Spinal Deformity Research Society / Korean Spinal Osteoporosis Research Society / NASS / Eurospine / ISASS / AO Spine /

AANS / AANS/CNS Section on Disorders of the Spine & Peripheral Nerves / World Spine Society / WCMISST / ACMISST / ISMISS KOREA, TURKEY,

JAPAN / Korean Society of Thermology / Korean Pain Society / Korean Neuro-Pain Society / The Korean Society of IMS

Best article award in the Korean Neurosurgical Society / Best Paper Award in the 6h ISMISS TURKEY / Best article award in The Korean IMS Therapy Association

AWARDS

Kim HS et al. Balloon kyphoplasty in severe osteoporotic compression fracture: Is it a contraindication? Neurosurgery 2007

Kim HS et al. Bone Cement Augmentation of Short Segment Fixation for Unstable Burst Fracture in Severe Osteoporosis. JKNS 2008

Kim HS et al. Endoscopic Transforaminal Suprapedicular Approach in High Grade Inferior Migrated Lumbar Disc Herniation. JKNS 2009

Kim HS et al. Minimally Invasive Multi-Level PLIF Using a Percutaneously Inserted Spinal Fixation System. JKNS 2011

Kim HS et al. Comparative study between different PEILD techniques. Pain Physician 2013

PAPERS: MORE THAN 40 PAPERSPAPERS: MORE THAN 40 PAPERS

Korean Neurosurgical Society: Luncheon Seminar: PELD; Benefits and Limitations / WCMISST 2012, Brazil: Minimally invasive TLIF and PLIF using

the Apollon system / WFNS 2013, Korea: Structural Preservation PEID

KNS / WFNS (World Federation of Neurosurgical societies) / NASS / Eurospine / ISAS / World Spine / KOMISS / ACMISST / Asia Spine / WCMISST /

ISMISS TURKEY / IITS / WENMISS

LECTURE & PRESENTATION: MORE THAN 100 TIMESLECTURE & PRESENTATION: MORE THAN 100 TIMES

REFERENCE DOCTOR

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Posterior Short Segment Fusionrecently been favored in the treatment of thoracolumbar burst fracture

Posterior Short Segment Fusionrecently been favored in the treatment of thoracolumbar burst fracture

Posterior Approach Extensive dissection of paraspinal muscles of the back

May lead to muscular denervation & necrosis

Resulting in prolonged postoperative pain and disability

Resection of posterior elements of the spine

Surgical treatment of burst fracturesSurgical treatment of burst fractures

An extensive, huge & very invasive procedure that requires a large opening with a long skin incision

PSF for TLBFs GOALS

Goals of surgical treatment for thoracolumbar burst fracturesGoals of surgical treatment for thoracolumbar burst fractures

Restore stability of the vertebral column

Decompress the spinal canal

Facilitate early mobilization of the patients

PSF for TLBFs GOALS

Non-fusion percutaneous screwing

Short Segment Instrumentation

Implant removal

Preservation of motion segment

Reducing the kyphotic deformity

PSF for TLBFs GOALS PERCUTANEOUS SHORT SEGMENT FIXATION FOR TLBFS

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OPERATION PROCEDURES RATIONALE

1) Preoperative postural pillow reduction: 1-2 days to achieve the initial restoration of canal compromise

to achieve the initial restoration of vertebral height

under the normal spinal alignment

2) Fractured vertebral augmentation PMMA (with osteoporosis) or non-PMMA materials (without osteoporosis)

to maintain the restored vertebral height

to increase the anterior column loading

3) Lordotic, posterior column compressive, percutaneous screwing Apollon System, Solco Medical, South Korea

to achieve the continuous additional restoration of canal compromise

under the low loading to the middle column

4) Bone Fusion Fracture site itself

5) Implant Removal After more than 6 months later from percutaneous screwing

Solid fusion of the fracture vertebrae by CT images

OPERATION PROCEDURES OSTEOPOROSIS

Non-osteoporotic fracture vertebrae

Non-PMMA fracture vertebral augmentation

Osteoporotic fracture vertebrae

PMMA fracture vertebral augmentation

Based on the Osteoporosis of the Fx Vertebrae

OPERATION PROCEDURES POSTURAL REDUCTION

Preoperative: Pillow reduction: 1~2 days

Intraoperative: Pressure Compression

OPERATION PROCEDURES VERTEBRAL AUGMENTATION

Kim HS. Journal of Korean Neurosurgical Society

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OPERATION PROCEDURES PERCUTANEOUS SCREWING

Lordotic, Posterior Column Compressive

OPERATION PROCEDURES IMPLANT REMOVAL

OPERATION PROCEDURES IMPLANT REMOVAL OPERATION PROCEDURES IMPLANT REMOVAL

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OPERATION PROCEDURES RESULT REFERENCES

Kim HY, Kim HS et al. Short Segment Screw Fixation without Fusion for

Unstable Thoracolumbar and Lumbar Burst Fracture : A Prospective Study on

Selective Consecutive Patients. J Korean Neurosurg Soc. 2012

CONCLUSION: Short segment pedicle screw fixation, including fractured level itself,

without bone fusion following postural reduction can be an effective and safe operative

technique in the management of selected young patients suffering from unstable burst

fracture.

REFERENCES

Kim HS et al. Short segment fixation for thoracolumbar burst fracture accompanying

osteopenia : a comparative study. J Korean Neurosurg Soc. 2013

Conclusion : Bone cement augmented procedure can be an efficient and safe surgical

techniques in terms of achieving better outcomes with minimal complications for

thoracolumbar burst fracture accompanying osteopenia.

REFERENCES

Kim HS et al. Implant Removal after Percutaneous Short Segment

Fixation for TLBF : Does It Preserve Motion? JKNS, 2014

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CASES 29yr / Female, L1 Bursting Fracture CASES 40yr / Female, L1 Bursting Fracture

CASES 40yr / Female, L1 Bursting Fracture CASES 43yr / Male, L3 Bursting Fracture

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CASES 16yr / Male, L3 Bursting Fracture CASES 72yr / Female, L1 Bursting Fracture

CASES 52yr / Female, T12 Bursting Fracture CASES PSF for Kümmell’s Disease

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CASES 68yr / Female, L2 Bursting Fracture CASES 21yr / Female, L3 Bursting Fracture

Low Extremities Motor: G1/G1

Sensory: Sensory loss: anal and genital area

Anal tone (weak)

Complete Bed Rest State

CASES 21yr / Female, L3 Bursting Fracture CASES 21yr / Female, L3 Bursting Fracture

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CASES 21yr / Female, L3 Bursting Fracture

2 weeks 4 weeks

10 weeks

Thank you !