A minimally invasive surgery combining temporary percutaneous pedicle screw fixation without fusion and vertebroplasty with transpedicular intracorporeal hydroxyapatite blocks grafting for fresh thoracolumbar burst fractures: prospective study

  • Masanari TakamiEmail author
  • Hiroshi Yamada
  • Kazuhiro Nohda
  • Munehito Yoshida
Original Article



The conventional surgical treatment for thoracolumbar burst fractures is physically invasive for the patient and also causes problems such as the sacrifice of healthy mobile segments to stabilize the fracture site. We performed a procedure for the treatment of fresh thoracolumbar burst fractures by combining percutaneous short pedicle screw fixation and vertebroplasty with transpedicular intracorporeal hydroxyapatite blocks grafting.


Patients with type A3 fresh thoracolumbar burst fractures with no or mild neurological symptoms were treated using temporary posterior fixation without fusion. Consecutive 21 patients were studied, with a mean age of 45.4 years (range 23–73) and a mean follow-up period of 21.9 months (range 15–25). We evaluated operative time, estimated blood loss, low back pain on a visual analogue scale, change in the kyphotic angle, correction loss, bone union, and complications.


The average operative time was 95.7 min (range 69–143), and the average blood loss was 38.6 mL (range 10–130). The average correction angle was 9.6°. There were slight correction losses of height of the vertebral bodies. Bone union was obtained in all patients, with no instrumentation failures. Our procedure resulted in no surgery-related complications.


For the treatment of type A3 fresh thoracolumbar burst fractures, this method is less invasive and can preserve the adjacent healthy mobile segment. Our treatment is an optional therapeutic strategy for patients with thoracolumbar burst fractures and is a good option particularly for young adult patients.


Thoracolumbar burst fracture Minimally invasive surgery (MIS) Percutaneous pedicle screw fixation Vertebroplasty Hydroxyapatite blocks Temporary fixation without fusion 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Denis F, Armstrong GW, Searls K, Matta L (1984) Acute thoracolumbar burst fractures in the absence of neurologic deficit. a comparison between operative and nonoperative treatment. Clin Orthop Relat Res 189:142–149PubMedGoogle Scholar
  2. 2.
    Denis F (1983) The three column spine and its significant in the classification of acute thoracolumbar spine injuries. Spine 8:817–831PubMedCrossRefGoogle Scholar
  3. 3.
    Kaneda K, Abumi K, Fujiya M (1984) Burst fractures with neurologic deficits of the thoracolumbar-lumbar spine. result of anterior decompression and stabilization with anterior instrumentation. Spine 9:788–795PubMedCrossRefGoogle Scholar
  4. 4.
    Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201PubMedCrossRefGoogle Scholar
  5. 5.
    Beringer W, Potts E, Khairi S, Mobasser JP (2007) Percutaneous pedicle screw instrumentation for temporary internal bracing of nondisplaced bony chance fractures. J Spinal Disord Tech 20:242–247PubMedCrossRefGoogle Scholar
  6. 6.
    Blondel B, Fuentes S, Pech-Gourg G, Adetchessi T, Tropiano P, Dufour H (2011) Percutaneous management of thoracolumbar burst fractures: evolution of techniques and strategy. Orthop Traumatol Surg Res 97:527–532PubMedCrossRefGoogle Scholar
  7. 7.
    Fuentes S, Blondel B, Metellus P, Metellus P, Gaudart J, Adetchessi T, Dufour H (2010) Percutaneous kyphoplasty and pedicle screw fixation for the management of thoraco-lumbar burst fractures. Eur Spine J 19:1281–1287PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Korovessis P, Hadjipavlou A, Repantis T (2008) Minimal invasive short posterior instrumentation plus balloon kyphoplasty with calcium phosphate for burst and severe compression lumbar fractures. Spine 33:658–667PubMedCrossRefGoogle Scholar
  9. 9.
    Maciejczak A, Barnas P, Dudziak P, Jaqiello-Bajer B, Litwora B, Sumara M (2007) Posterior keyhole corpectomy with percutaneous pedicle screw stabilization in the surgical management of lumbar burst fracture. Neurosurgery 60:232–241PubMedCrossRefGoogle Scholar
  10. 10.
    Ni WF, Huang YX, Chi YL, Xu HZ, Lin Y, Wang XY, Huang QS, Mao FM (2010) Percutaneous pedicle screw fixation for neurologic intact thoracolumbar burst fractures. J Spinal Disord Tech 23:530–537PubMedCrossRefGoogle Scholar
  11. 11.
    Rampersaud YR, Annand N, Dekutoski MB (2006) Use of minimally invasive surgery techniques in the management of thoracolumbar trauma. Spine 31:S96–S102PubMedCrossRefGoogle Scholar
  12. 12.
    Sahin S, Resnick DK (2005) Minimally incisional stabilization of unstable L5 burst fracture. J Spinal Disord Tech 18:455–457PubMedCrossRefGoogle Scholar
  13. 13.
    Toyone T, Tanaka T, Kato D, Kaneyama R, Otsuka M (2006) The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation: a prospective study. Spine 31:E208–E214PubMedCrossRefGoogle Scholar
  14. 14.
    Dai LY, Jiang LS, Jiang SD (2008) Conservative treatment of thoracolumbar burst fractures: a long-term follow-up results with special reference to the load sharing classification. Spine 33:2536–2544PubMedCrossRefGoogle Scholar
  15. 15.
    Rajasekaran S (2010) Thoracolumbar burst fractures without neurological deficit: the role for conservative treatment. Eur Spine J 19(Suppl 1):S40–S47PubMedCrossRefGoogle Scholar
  16. 16.
    Weninger P, Schultz A, Hertz H (2009) Conservative management of thoracolumbar and lumbar spine compression and burst fractures: functional and radiographic outcomes in 136 cases treated by closed reduction and casting. Arch Orthop Trauma Surg 129:207–219PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • Masanari Takami
    • 1
    Email author
  • Hiroshi Yamada
    • 1
  • Kazuhiro Nohda
    • 1
  • Munehito Yoshida
    • 1
  1. 1.Department of Orthopaedic SurgeryWakayama Medical UniversityWakamayaJapan

Personalised recommendations