Awake Percutaneous Fixation for Unstable Fractures of the Spine in High-risk Patients: A Retrospective Study. Issue 15 (1st August 2022)

• Record Type: Journal Article
• Authors: Valero-Moreno, Eduardo; Kaplan, Leon; Bineth, Noa; Cohen, Jose; Schroeder, Josh E.
• Is Part Of: Journal of the American Academy of Orthopaedic Surgeons. Volume 30:Issue 15(2022)
• Page Start: e1033
• Page End: e1042
• Publication Date: 2022-08-01
• Subjects: Orthopedics -- Periodicals; Orthopedic surgery -- Periodicals; Joint Diseases -- Periodicals; Orthopedics -- Periodicals; Orthopedic surgery; Orthopedics; Periodicals; 616.7005
• DOI: 10.5435/JAAOS-D-21-00959
• Languages: English
• ISSNs: 1067-151X

Abstract

Abstract : Introduction: Unstable fractures in sick or elderly patients are on the rise. These patients who are at high risk for surgery present a challenge for surgeons and anesthesiologists. In patients with American Society of Anesthesiologists (ASA) scores 3 to 4, the risk is even higher because of the high rate of intraoperative complications. Methods: All patients with ASA scores 3 to 4 who presented with unstable fractures of the spine to a level-one trauma center were assessed, and they underwent awake spinal percutaneous fixation, with mild sedation and local anesthesia. Demographics, radiology, and the outcome were collected. Results: Nineteen patients were operated between the years 2019 and 2021. Average follow-up was 12 months (range 8 to 24 months); six patients were female and 13 males. The average age was 77.7 years; the ASA score was 3 to 4 in all patients. There were 10 extension-type injuries, six unstable burst injuries, two chance fractures, and one teardrop fracture. All patients underwent unilateral fixation, and just one patient underwent bilateral fixation; cement augmentation was done in 16 of the patients. No neurologic complication was observed. One case of infection presented 4 months after surgery. All patients were discharged ambulating. Conclusions: Awake fixation in extreme cases is safe and feasible; a dedicated team including an anesthesiologist and radiologist is needed to treat these cases safely and quickly.