Percutaneous, PMMA-augmented, pedicle screw instrumentation
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Fractures in the ankylotic spine may have an insidious presentation but are prone to displace with devastating consequences. The long lever arm of ankylosed spine fragments may lead to pulmonary and great vessel injury and is difficult to adequately immobilize.

In recent years, percutaneous instrumentation of non-ankylotic spine fractures has gained popularity, producing similar outcomes to open surgery with shorter operative times and reduced blood loss and hospital length of stay.

All patients treated for thoracolumbar spine fractures with a diagnosis of ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperostosis (DISH) were included. Operative and postoperative data, results, and complications were tabulated, and radiographic parameters were evaluated.

--24 patients with ankylotic spine disease underwent percutaneous augmented instrumentation. The mean age was 76. All patients had at least one comorbidity.

--The mean number of ankylosed levels was 14. Mean operative time was 131 min. The average postoperative hemoglobin decrease was 1.21 gr/%, with only 4 patients requiring blood transfusion.

--45.8% of the patients had postoperative medical complications. 1 patient had a superficial postoperative infection, and one patient died in hospital. The average hospital length of stay was 14.55 days.

--All patients retained their preoperative ASIA grades, and 3 improved one grade. All patients united their fractures without losing reduction.

Finally, as compared to other existing surgical options, PMMA-augmented percutaneous instrumentation is an appealing surgical choice for this challenging patient subset.