Microcirculation in open vs. minimally invasive dorsal stabilization of thoracolumbar fractures

<div><p>Standard open and percutaneous minimally invasive surgical procedures co-exist in the treatment of fractures of the thoracolumbar spine. Shorter skin incisions just above the pedicles are used in minimally invasive procedures. Full-length skin incisions and invasive preparations are applied in the standard open approach. While both methods show equivalent rates of intraoperative surgical complications and comparable clinical and radiological outcomes, blood loss and operation time have shown to be decreased in minimally invasive treatment. However, no study so far has investigated differences in microcirculation. This study hypothesized less impairment of microcirculation in the minimally invasive approach compared to the open approach and an improvement of microcirculation over time. A prospective cohort study was conducted using non-invasive laser-Doppler spectrophotometry (an O2C “oxygen to see” device) for measurement of cutaneous and subcutaneous blood oxygenation (SO₂), haemoglobin concentration (Hb), and blood flow at depths of 2, 8, and 15 mm at six locations on the skin. Measurements were performed before surgery, 8 and 24 h after surgery, and 2, 4, 7, 12 and 20 days after surgery, however the number of patients measured decreased towards the later time points. Forty patients were included in the study, 20 with each approach (18 females and 22 males). Pair-wise comparison of the types of surgical procedure for each measurement point revealed a significantly higher flow value in the minimally invasive group at one of the measurement points located between the incisions (P = .041). The point-wise analyses of SO₂ and Hb did not show significant differences between the approaches. In conclusion, significantly albeit moderately higher flow values could be found in minimally invasive procedures compared to open operations of thoracolumbar fractures in the area of skin that is spared by the incisions.</p></div

Positioning of the O2C probe and skin incisions.

<p>Positioning of the O2C probe and skin incisions.</p

Results over all time and measurement points.

<p>Figures show mean values with standard deviation. The standard open approach (SO) is displayed in dark grey, the minimally invasive approach (MI) in light grey. No significant differences were found between operation types in any of the measured parameters arranged by measurement depth. Independent of operation type, the flow differed significantly between depth levels.</p

Demographics, injury severity (ISS), mortality and abbreviated injury score for thoracic injury (AIS_Thorax) between 2005 and 2014.

<p>Demographics, injury severity (ISS), mortality and abbreviated injury score for thoracic injury (AIS_Thorax) between 2005 and 2014.</p

CT-scan.

<p>Illustration of the pelvic model during the preoperative CT-scan.</p

Significant decrease of sepsis, MOF and but not mortality rates between 2005 and 2014.

<p>Significant decrease of sepsis, MOF and but not mortality rates between 2005 and 2014.</p