Spinal Fracture Fixation

Spinal fracture can be primary due to injury or secondary (pathological- in an already weak bone). Vertebral fixation (also known as "spinal fixation") is surgical  procedure in which two or more vertebrae are anchored to each other through a synthetic "vertebral fixation device", with the aim of reducing vertebral mobility and thus avoiding possible damage to the spinal cord and/or spinal roots.

Indications
A vertebral fracture fixation procedure may be indicated in cases of:
1) vertebral fracture leading to neurological injury.
2) Vertebral fracture with impending neurological injury.
Types of Fixations: The implants used to achieve vertebral fixation are usually a permanent rigid or semi-rigid prosthesis made of titanium like rods, plates, screws, and various combinations thereof. The surgery may be open or minimally invasive (like minimally invasive transforaminal lumbar interbody fusion or percutaneous fracture stabilization).

The types of fracture fixation may include:
1) Cervical:
 Anterior cervical plating with or without corpectomy.
 Anterior cervical cage insertion and plating.
 Posterior cervical lateral mass screw fixation and stabilization.
 Anterior or posterior stabilization with neurological decompression.

2) Thoracic:
 Percutaneous dorsal fracture stabilization. (minimally invasive)
 Open dorsal fracture stabilization.
 Thoracic fracture fixation with laminectomy (decompression) and anterior cage support.
 Kyphoplasty/vertebroplasty for fractured vertebra.
 Anterior transthoracic approach for fracture fixation and anterior column reconstruction (cage)

3) Lumbar/Lumbo-sacral:  Posterior percutaneous fracture fixation (minimally invasive)  Posterior open spinal fixation with fusion.
 Posterior spinal fixation with anterior cage insertion.
 Kyphoplasty/vertebroplasty.
 Anterior lumbar fixation with corpectomy and mesh cage support.
 Axial lumbar interbody fusion .
 Direct lateral lumbar interbody fusion.
 Lumbo sacral spinal fixation.
Normally the pedicles screws used for posterior stabilization are connected with rods on both the sides, whereas the anterior assembly normally uses a plate and screw mechanism, e.g in cervical spine.
In cases with severe osteoporosis cement augmented screws are also available to increase the hold in weak bone.
Normally after spinal fracture fixation a protective brace is worn for additional support till the fracture heals.

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