163 / 198
Speaker Presentation Abstracts
AANS01 Acute Challenges in the Unstable Spine
AANS01-01
CERVICAL TRACTION FOR THE TREATMENT OF
UNSTABLE SUBAXIAL INJURIES
Jason Huang
Baylor Scott & White/ Texas A&M HSC College of Medicine, De-
partment of Neurosurgery, Temple, USA
Following acute cervical spine trauma, traction can be used to restore
sagittal plane alignment in patients with subaxial injuries. Furthermore, it
can reduce unilateral or bilateral cervical facet dislocations, and to improve
alignment in patients with traumatic spondylolisthesis of the axis. We here
report our institutional experience treating both adult and pediatric patients
with acute unstable cervical spinal trauma using skull traction
+
/
-
sur-
gical stabilization. Our experience suggests that the use of cervical traction
may obviate the need for operative treatment for some patients with
atlanto-axial rotatory subluxation. Additionally, our use of perioperative
and intraoperative spinal traction has been shown to assist with preoper-
ative planning and to improve overall correction and pulmonary function
in patients with spinal deformity. Our data suggest that the most common
complications associated with cervical spine traction include pin-site in-
fection, pain and neuroma formation; however, more serious neurological
complications, including cranial nerve palsy and spinal cord injury, al-
though rare, could also occur; thus, careful monitoring of patients under-
going traction is essential. A review of the literature is provided.
Keywords: unstable spine, cervical traction, spinal injury
AANS01-02
LATERAL APPROACH TO SPINE TRAUMA
William Smith
UMC of Southern Nevada, Chief of Neurosurgery, Las Vegas, USA
Traditionally, several approaches have been utilized to address spinal
trauma pathologies. Such posterior approaches include the lami-
nectomy, transpedicular and costotransversectomy approaches. Tradi-
tional anterior approaches include open thoracotomy and endoscopic
thoracotomy. These traditional approaches allow for varying degrees of
neural decompression, but they are also generally highly morbid. The
lateral approach for spine trauma allows for a significant neural de-
compression and placement of a robust vertebral body replacement
device with minimized morbidity. This approach was studied by Drs.
Dakwar, Le, Uribe, and Smith (
Minimally Invasive Surgery for Trau-
matic Spinal Pathologies.
Spine. Volume 35, Number 26S, ppS338-
S346). In a series of 52 patients, key findings include average operative
time of 128 mins, average estimated blood loss of 300mL, avoidance of
chest tube placement in all but 2 cases, and a 13.5% complication rate.
The presenter has also studied the impact of utilizing the lateral ap-
proach within 4 hours of injury to treat patients with complete motor
and sensory deficit at the level of fracture. In a series of 8 patients
treated within this criteria, 4 patients improved ASIA by 2 or more
levels, and no significant surgical related morbidities occurred. In
conclusion, the lateral approach provides significant clinical benefits
over traditional approaches for the treatment of spinal trauma.
Keywords: Minimally Invasive Surgery, Lateral approach/fixation,
XLIF, Corpectomy, Neural decompression, Vertebral fracture
AANS01-03
TRAUMATIC THORACOLUMBAR SPINAL INJURY: AN
ALGORITHM FOR MINIMALLY INVASIVE SURGICAL
MANAGEMENT
Sanjay Dhall
UCSF, Department of Neurological Surgery, San Francisco, USA
Object:
Minimally invasive spinal (MIS) surgery techniques have been
used sporadically in thoracolumbar junction trauma cases in the past 5 years.
A review of the literature on the treatment of thoracolumbar trauma treated
with MIS surgery revealed no unifying algorithm to assist with treatment
planning. Therefore, the authors formulated a treatment algorithm.
Methods:
The authors reviewed the current literature on MIS
treatment of thoracolumbar trauma. Based on the literature review,
they then created an algorithm for the treatment of thoracolumbar
trauma utilizing MIS techniques. This MIS trauma treatment algo-
rithm incorporates concepts form the Thoracolumbar Injury Classifi-
cation System (TLICS).
Results:
The authors provide representative cases of patients with
thoracolumbar trauma who underwent MIS surgery utilizing the MIS
trauma treatment algorithm. The cases involve the use of mini-open
lateral approaches and/or minimally invasive posterior decompression
with or without fusion.
Conclusions:
Cases involving thoracolumbar trauma can safely be
treated with MIS surgery in select cases of burst fractures. The role of
percutaneous nonfusion techniques remains very limited (primarily to
treat thoracolumbar trauma in patients with a propensity for autofu-
sion [for example, those with ankylosing spondylitis).
Keywords: Minimally invasive spinal (MIS) surgery, Thor-
acolumbar Injury Classification System (TLICS), burst fractures,
thoracolumbar trauma
AANS02 Acute Surgical Cranial Trauma - To Drill or
Not To Drill: That Is the Question
AANS02-01
CONTROVERSIES IN INTRACRANIAL MONITORING
Martina Stippler
Harvard, Neurosurgery, Boston, USA
A-127