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Background: Minimally invasive stabilization of thoracolumbar osteoporotic fractures (OF) in neurologically intact patients is well established. Various posterior and anterior surgical techniques are available. The OF classification and OF score are helpful for defining the indications and choice of operative technique., Objective: This article gives an overview of the minimally invasive stabilization techniques, typical complications and outcome., Material and Methods: Selective literature search and description of surgical techniques and outcome., Results: Vertebral body augmentation alone can be indicated in painful but stable fractures of types OF 1 and OF 2 and to some extent for type OF 3. Kyphoplasty has proven to be an effective and safe procedure with a favorable clinical outcome. Unstable fractures and kyphotic deformities (types OF 3-5) should be percutaneously stabilized from posterior. The length of the pedicle screw construct depends on the extent of instability and deformity. Bone cement augmentation of the pedicle screws is indicated in severe osteoporosis but increases the complication rate. Restoration of stability of the anterior column can be achieved through additional vertebral body augmentation or rarely by anterior stabilization. Clinical and radiological short and mid-term results of the stabilization techniques are promising; however, the more invasive the surgery, the more complications occur., Conclusion: Minimally invasive stabilization techniques are safe and effective. The specific indications for the individual procedures are guided by the OF classification and the individual clinical situation of the patient.

This paper gives recommendations for treatment of thoracolumbar and lumbar spine injuries. The recommendations are based on the experience of the involved spine surgeons, who are part of a study group of the "Deutsche Gesellschaft für Unfallchirurgie" and a review of the current literature. Basics of diagnostic, conservative, and operative therapy are demonstrated. Fractures are evaluated by using morphologic criteria like destruction of the vertebral body, fragment dislocation, narrowing of the spinal canal, and deviation from the individual physiologic profile. Deviations from the individual sagittal profile are described by using the monosegmental or bisegmental end plate angle. The recommendations are developed for acute traumatic fractures in patients without severe osteoporotic disease.

Techniques of percutaneous spinal instrumentation have in the meantime become standard methods in many hospitals. While several indications have been established that are excellently suited to this technique, uncertainty prevails for other indications. This contribution intends to clarify the technical prerequisites for performing percutaneous instrumentation in the region of the thoracic and lumbar spine in addition to describing customary indications and various techniques of percutaneous instrumentation. This is combined with a critical assessment of what intrinsically cannot or cannot yet be achieved with a percutaneous approach to illustrate that the percutaneous procedure can by no means be considered a mere evolution of the previous classic open techniques.

Question: This retrospective study presents results after conservative and operative treatment of thoracolumbar fractures as function of its localization., Methodology: In 2 years 70 patients with A1/A2 fracture were conservatively treated, 38 patients with A3/B/C injury were treated by internal fixtor. For evaluation 3 vertebral sections(Th5-10,Th11-L2,L3-5)were defined. Follow-up took place 1 year after implant removal or end of conservative treatment., Results: The correction-loss was highest in thoracic, lowest in lumbar region. After conservative therapy,correction-loss was located to 3/4 in vertebra itself, after operative treatment especially in adjacent disc spaces. There was no general correlation to complaints., Conclusion: In consequence of these results A1/A2-fractures in the upper thoracic spine (15 degrees will be stabilized anteriorly, in other regions functional treated. A3-fractures of thoracic spine and thoracolumbar junction will be operated from anterior, in lower lumbar spine (>L3) from dorsal. B- and C-injuries should be instrumented with a combined dorsoventral procedure.

Irrespective of an anterior open or endoscopic approach, the combined postero-anterior instrumentation of thoracolumbar fractures requires time consuming intraoperative maneuvers changing the patients position from prone to lateral.A standardised anterior endoscopically assisted approach for the segments Th4 to L4 is described, allowing the patient to remain in prone position, using a 4-5cm incision combined with a retractor system. The approach to the anterior spine in prone position is feasible by using a self holding retractor system for the region from Th4 to L4. Time of anaesthesia for the one stage combined procedure can be reduced by about 40 min, when changing the position of the patient is no longer necessary. The minimal incision in combination with the retractor system allows mainly the use of conventional instruments and implants, which provides reasonable lower costs. The advantages of the open and the endoscopical technique are combined. The main advantage of the prone position is the opportunity to access the anterior and posterior spine simultaneously, which is extremely helpful in reduction maneuvers.

In a 32 years old professional handball layer, the micro-traumata typical of this game led to retropatellar cartilage lesion, which became sympthomatic following an distortion-impact trauma. Since the patient remains symptomatic after initial conservative treatment as well as arthroscopic chondroplastic, osteo-chondral transplantation was performed. There was a good functional result 6 months after surgery.