Abstract
Background
Internal fixation of unstable thoracolumbar spine fractures requires correction of the lacking anterior column support. This usually entails insertion of a vertebral body replacement strut through an anterior approach, or a long posterior construct spanning at least two vertebrae above and two vertebrae below the fracture. Posterior short-segment pedicle instrumentation (SSPI)—one vertebra above and below—is suitable for approximately 40% of fractures, but not for all.
Methods
A total of 52 patients with unstable thoracolumbar burst fractures meeting our inclusion criteria were instrumented using a novel approach, combining percutaneous SSPI, pedicle screw augmentation with polymethyl methacrylate (PMMA) and fractured vertebra kyphoplasty. We retrospectively reviewed patient and fracture data, operative results and 1 year radiographic follow-up postoperatively in 40 of the patients. We reviewed operative complications of all 52 patients.
Results
Most fractures were AO/Magerl type A3.1, A3.2 and A3.3. They were instrumented within 72 h and ambulated without additional external bracing. Operative time averaged 2 h and blood loss was less than 50 cc in most cases. Complications were mostly related to PMMA leakage. On average, 3.3° (0–13) of correction was lost after 3 months, but remained constant afterward.
Conclusions
Percutaneous augmented short-segment pedicle instrumentation of unstable thoracolumbar fractures can be done with short operative times, minimal blood loss and a low complication rate. The radiographical results at 1 year are equal to anterior stabilization and are better than other posterior-only techniques.
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References
Mikles MR, Stchur RP, Graziano GP (2004) Posterior Instrumentation for thoracolumbar fractures. J Am Acad Orthop Surg 12:424–435
Schinkel C, Anastasiadis AP (2008) The timing of spinal stabilization in polytrauma and in patients with spinal cord injury. Curr Opin Crit Care Dec 14(6):685–689
Schinkel C, Frangen TM, Kmetic A, Andress HJ, Muhr G, German Trauma Registry (2006) Timing of thoracic spine stabilization in trauma patients: impact on clinical course and outcome. J Trauma 61(1):156–160. (Discussion 160)
McLain RF, Sparling E, Benson DR (1993) Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Jt Surg Am 75(2):162–167
Parker JW, Lane JR, Karaikovic EE, Gaines RW (2000) Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2-year series. Spine 25(9):1157–1170
Afzal S, Akbar S, Dhar SA (2008) Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience. Eur Spine J 17(3):336–341
Pflugmacher R, Agarwal A, Kandziora F, K-Klostermann C (2009) Balloon kyphoplasty combined with posterior instrumentation for the treatment of burst fractures of the spine–1-year results. J Orthop Trauma 23(2):126–131 PubMed PMID: 19169105
Marco RA, Kushwaha VP (2009) Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction. J Bone Joint Surg Am 91(1):20–28 PubMed PMID: 19122075
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(6):658–667
Acosta FL Jr, Aryan HE, Taylor WR, Ames CP (2005) Kyphoplasty-augmented short-segment pedicle screw fixation of traumatic lumbar burst fractures: initial clinical experience and literature review. Neurosurg Focus 18(3):e9 PubMed PMID: 15771399
Cho DY, Lee WY, Sheu PC (2003) Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation. Neurosurgery 53(6):1354–1360
Magerl F, Aebi M, Gertzbein S, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201
Payer M (2006) Unstable burst fractures of the thoraco-lumbar junction:treatment by posterior bisegmental correction/fixation and staged anterior corpectomy and titanium cage implantation. Acta neurochir (Wien) 148:299–306
Ragel B, Kan P, Schmidt M (2010) Blood transfusions after thoracoscopic anterior thoracolumbar vertebrectomy. Acta Neurochir 152:597–603
Venmans A, Lohle PN, van Rooij WJ, Verhaar HJ, Mali WP (2008) Frequency and outcome of pulmonary polymethylmethacrylate embolism during percutaneous vertebroplasty. AJNR 29(10):1983–1985
Kim YJ, Lee JW, Park KW, Yeom JS, Jeong HS, Park JM, Kang HS (2009) Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors. Radiology 251(1):250–259
Webb JC, Spencer RF (2007) The role of polymethylmethacrylate bone cement in modern orthopaedic surgery. J Bone Joint Surg Br 89(7):851–857
Burval DJ, McLain RF, Milks R, Inceoglu S (2007) Primary pedicle screw augmentation in osteoporotic lumbar vertebrae. Spine 32(10):1077–1083
Fuentes S, Blondel B, 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(8):1281–1287
Palmisani M, Gasbarrini A, Brodano GB, De Iure F, Cappuccio M, Boriani L, Amendola L, Boriani S (2009) Minimally invasive percutaneous fixation in the treatment of thoracic and lumbar spine fractures. Eur Spine J 18(Suppl 1):71–74
Acknowledgments
Research funds have been received during the preparation of this work from the following: The Western Galilee Hospital, Israel Spine Society, Medtronic Israel, Tzamal-Jakobsohn Ltd., Israel.
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Rahamimov, N., Mulla, H., Shani, A. et al. Percutaneous augmented instrumentation of unstable thoracolumbar burst fractures. Eur Spine J 21, 850–854 (2012). https://doi.org/10.1007/s00586-011-2106-x
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DOI: https://doi.org/10.1007/s00586-011-2106-x