Minimally invasive spine surgery (MISS) techniques have advanced in the recent decade, primarily championed for degenerative lumbar disorders, and are now a valuable treatment modality for deformity, tumor, infection, and trauma. Minimally invasive techniques represent a valuable option for trauma patients who may have concurrent life-threatening injuries. These techniques allow for rapid stabilization of the injury, which permits early patient mobilization, one of the key principles in the care of a critically injured patient.

The advent of new surgical technology such as modern fluoroscopy and cannulated pedicle screw systems has facilitated the application of minimally invasive surgery to the field of spinal trauma. The incidence of spinal injury in the United States has been reported to be as high as 6.3% in patients with blunt trauma. This equates to nearly 150,000 patients with vertebral column injury per year in North America alone. The most common mechanism of injury is motor vehicle collisions, followed by falls from height, and domestic violence. The most commonly injured area of the thoracic and lumbar spine is the thoracolumbar junction; over 50% of thoracolumbar fractures occur at T12-L3.¹ These injuries can impart significant long-term sequela and pose a large financial impact on both individual patients and society. The National Spinal Cord Injury Statistical Center estimates the lifetime direct costs for persons injured at age 25 range from 2.1 to 5.4 million dollars, varying by severity of injury. Much of this cost is attributable to improved life expectancy in the spinal cord injury population secondary to advances in care, higher-than-average hospital readmission rates in the recovery phase, and the costs of postaccident rehabilitation after spinal cord injury.²,³

In the past, techniques such as traction, casting, and bedrest were commonplace for fracture treatment, even as late as the 1990s. Without definitive stabilization, however, the complication rate of these nonoperative measures was high. With the advancement of minimally invasive technology, early stabilization of the spine has become the standard of care as this allows for early patient mobilization and facilitates appropriate nursing care. A large metaanalysis in 1992 by the Scoliosis Research Society demonstrated that surgical intervention leads to greater improvement in neurologic function when compared to nonoperative treatment, particularly in patients with deteriorating neurologic function. The same group also demonstrated that patients who underwent surgical stabilization had less residual deformity and improved pain.⁴

The concept of “damage control orthopedics,” coined by Scalea et al. in 2000 was first used to describe emergent external fixation of long bone fractures. External fixation provides stabilization and reduction while offering the advantage of a less morbid procedure—shorter surgical time, decreased blood loss, and early mobilization and rehabilitation. Early intervention with external fixation provides a bridge to definitive therapy, and minimizes the sustained physiologic burden from a more morbid procedure after the patient has already been subjected to a significant
physiologic blow from the trauma itself.⁵ Early fixation in spine trauma serves to stabilize the injury site and minimize further neurologic impairment, while minimizing the secondary physiologic burden seen with open procedures. Again, early mobilization remains key in the treatment of a poly-trauma patient.⁶ McHenry et al.⁷ demonstrated that early stabilization (less than 48 hours) of thoracolumbar fractures is associated with a decreased risk of respiratory failure in polytrauma patients. Respiratory failure developed in 140 of the 1,032 patients at a level I trauma center; time until operative stabilization was the only risk factor identified that could be controlled by the physician. MISS is reported to offer shorter surgical time, negligible blood loss, early mobilization, and prompt rehabilitation.⁸, ⁹, ¹⁰, ¹¹ Percutaneous MISS provides early benefits, while minimizing an increase in the physiologic burden to the already vulnerable trauma patient.