Percutaneous fixation of an L2 fracture

Previously, most vertebral fractures were treated conservatively: 6 weeks of strict bed rest, followed by a corset (whether or not in plaster) for 3 months. This had the benefit of avoiding surgery (thus also anaesthesia), but also had various drawbacks:

  • 6 weeks of bed rest
  • often insufficient healing, so that the broken vertebra still continued to collapse after this, resulting in pain

Today many vertebral fractures are treated surgically. The drawback is clearly that this involves surgery with the attendant risks. However, this does not outweigh the benefits:

  • more rapid rehabilitation
  • less pain
  • less deformation of the spinal column in the long term.

In this example, we follow the treatment of a man who fell from a ladder at work, breaking his second lumbar vertebra (L2). He had no signs of paralysis, but he was in pain.

On the CT scan examination we saw the break. We also saw a loose bone fragment that could start to press on the nerve.

We discussed with the man whether we should treat him conservatively or with surgery. He opted for surgery. We were able to use a new technique on him, namely percutaneous (= through the skin, without surgery) placement of a fixation system. For this operation we made use of neuronavigation technology and an intra-operative CT scan (O-arm).

Surgical technique

Under general anaesthesia (approximately one hour) four screws were inserted with the aid of a navigation system, two in the vertebrae on either side of each broken vertebra. Beyond the skin, the surgeon could no longer see what is happening, except on the virtual navigation system.

Once the four screws were placed, a CT scan was performed to verify the correct positioning of the screws.

After this, the screws were connected two by two, with two rods at a time, which were also introduced percutaneously. These rods were attached to the pedicle screws. In this way the fractured vertebra was fixed in the correct position and it could heal perfectly. After 6 weeks to 3 months the fracture was healed.

The patient in this example was able to leave hospital 4 days after the intervention. He wore a light corset and was allowed to walk around.