Der Unfallchirurg
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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. ⋯ 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.
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Injuries of the thoracolumbar junction are the most common fractures of the spine due to their anatomical position and load. Common classification systems differentiate between stable and unstable injuries and thus also between operative and conservative therapy. The majority of injuries can be treated conservatively; however, unstable injuries require surgical treatment for a variety of reasons. ⋯ Hybrid procedures are also possible. This also applies to the treatment of osteoporotic fractures, since a clear assignment between traumatic and osteoporotic cause is not always easy and possible. This article describes the principles, the possible indications, and limitations of minimally invasive posterior and anterior stabilization.
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Nowadays, although minimally invasive procedures are the standard for the treatment of thoracolumbar spinal injuries, these techniques are not yet established for the cervical spine. This is due to anatomical and technical reasons and also due to the fact that the classical anterior decompression and fusion procedure already fulfils the criteria of minimally invasiveness and is suitable for the vast majority of injuries. ⋯ There is a minimally invasive variant for nearly all open procedures, mainly in the upper cervical spine but also in the lower cervical spine. The further development of these promising techniques is still pending.
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Sacral fractures can be of traumatic origin and can also occur as insufficiency fractures. While the therapeutic target of mechanically stable insufficiency fractures is mainly pain relief, mechanically unstable insufficiency fractures and traumatic sacral fractures following high-energy trauma require biomechanical stabilization. Various surgical strategies are available for this, whereby minimally invasive techniques are now preferred whenever possible. ⋯ All surgical options have their indications. Nevertheless, the biomechanical stability which can be achieved differs widely. Therefore, an exact analysis should be carried out of what is necessary with respect to reduction and retention and what should be achieved when treating sacral fractures.