Thoracolumbar Burst Fractures Treated with Posterior Decompression and Pedicle Screw Instrumentation Supplemented with Balloon-Assisted Vertebroplasty and Calcium Phosphate Reconstruction

Marco, Rex A. W.; Meyer, B. Christoph; Kushwaha, Vivek P.
March 2010
Journal of Bone & Joint Surgery, American Volume;Mar2010 Supplement 1, Vol. 92-A, p67
Academic Journal
BACKGROUND: The treatment of unstable thoracolumbar burst fractures with short-segment posterior spinal instrumentation without anterior column reconstruction is associated with a high rate of screw breakage and progressive loss of reduction. The purpose of the present study was to evaluate the functional, neurologic, and radiographic results following transpedicular, balloon-assisted fracture reduction with anterior column reconstruction with use of calcium phosphate bone cement combined with short-segment posterior instrumentation and a laminectomy. METHODS: A consecutive series of thirty-eight patients with an unstable thoracolumbar burst fracture with or without neurologic deficit were managed with transpedicular, balloon-assisted fracture reduction, calcium phosphate bone cement reconstruction, and short-segment spinal instrumentation from 2002 to 2005. Twenty-eight of the thirty-eight patients were followed for a minimum of two years. Demographic data, neurologic function, segmental kyphosis, the fracture severity score, canal compromise, the Short Form-36 score, the Oswestry Disability Index score, and treatment-related complications were evaluated prospectively. RESULTS: All thirteen patients with incomplete neurologic deficits had improvement by at least one Frankel grade. The mean kyphotic angulation improved from 17° preoperatively to 7° at the time of the latest follow-up, and the loss of vertebral body height improved from a mean of 42% preoperatively to 14% at the time of the latest follow-up. Screw breakage occurred in two patients, and pseudarthrosis occurred in one patient. CONCLUSIONS: The present study demonstrates that excellent reduction of unstable thoracolumbar burst fractures with and without associated neurologic deficits can be maintained with use of short-segment instrumentation and a transpedicular balloon-assisted reduction combined with anterior column reconstruction with calcium phosphate bone cement performed through a single posterior incision. The resultant circumferential stabilization combined with a decompressive laminectomy led to maintained or improved neurologic function in all patients with neurologic deficits, with a low rate of instrumentation failure and loss of correction. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Pre-operative Amicar (Epsilon-Aminocaproic Acid): Does it reduce total blood loss in lumbar pedicle screw spinal fusion? Cardenas, Raul; Wadhwa, Rishi; Haydel, Justin; Nanda, Anil; Rao, Ashok; Caldito, Gloria // Internet Journal of Neurosurgery;2010, Vol. 7 Issue 1, p3 

    Objective and Importance: Chronic low back pain and radiculopathy due to spondylolisthesis and spinal instability are frequent indications for decompressive lumbar laminectomy and spinal fusion with pedicle screw fixation. This procedure frequently involves a great deal of intra-operative blood...

  • Development and validation of a quantitative method to assess pedicle screw loosening in posterior spine instrumentation on plain radiographs. Aghayev, Emin; Zullig, Nicolas; Diel, Peter; Dietrich, Daniel; Benneker, Lorin // European Spine Journal;Mar2014, Vol. 23 Issue 3, p689 

    Purpose: Currently, the diagnosis of pedicle screw (PS) loosening is based on a subjectively assessed halo sign, that is, a radiolucent line around the implant wider than 1 mm in plain radiographs. We aimed at development and validation of a quantitative method to diagnose PS loosening on...

  • Surgical images: musculoskeletal.  // Canadian Journal of Surgery;Apr2008, Vol. 51 Issue 2, p150 

    The article presents the case of a 7-year-old girl who was presented to the multinational medical unit at Kandahar Airfield in Afghanistan with an open lateral malleolus fracture. A cross leg flap was needed in this case. A sural neurocutaneous flap has been raised from the left contralateral...

  • ILIZAROV DISTRACTION HISTOGENESIS TO RECONSTRUCT MASSIVE POSTTRAUMATIC OSTEOARTICULAR DEFECTS. Kuo, Ken N.; Qureshi, Abid; Bush-joseph, Charles A.; Templeton, Alexander // Journal of Bone & Joint Surgery, American Volume;Jun2003, Vol. 85-A Issue 6, p1125 

    The article presents a report on the case of a three-year-old patient in whom massive osteoarticular bone loss from the medial tibial plateau of the left leg, due to a lawn-mower injury, was treated with the Ilizarov technique of distraction histogenesis. A three-year-old boy sustained an injury...

  • Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance: a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty. Sakai, Kenichiro; Yoshii, Toshitaka; Hirai, Takashi; Arai, Yoshiyasu; Shinomiya, Kenichi; Okawa, Atsushi // European Spine Journal;Jan2017, Vol. 26 Issue 1, p104 

    Purpose: Cervical sagittal balance has received increased attention as an important determinant of radiological and clinical outcomes. However, no prospective studies have compared the impact of cervical sagittal balance between anterior and posterior surgeries. We previously...

  • Clinical Evaluation of TruFUSE® Lumbar Facet Fusion System. Maroon, Joseph C.; Bost, Jeff W.; LePere, Darren B.; Bost, Stephanie M.; Williams, Louis; Amos, Austin S. // Surgical Science;Feb2013, Vol. 4 Issue 2, p166 

    Introduction: The TruFUSE® lumbar facet fusion system is a unique allograft milled bone dowel used to fuse facet joints. We evaluated subjects undergoing TruFUSE® fusion for stable grade I spondylolisthesis and stenosis comparing operative time, length of stay, blood loss and outcome to a...

  • Thoracic pedicle screw placement: Free-hand technique. Kim, Yongjung J.; Lenke, Lawrence G. // Neurology India;Dec2005, Vol. 53 Issue 4, p512 

    The article offers a free-hand technique for thoracic pedicle screw placement. The thoracic pedicle screws provide numerous advantages over other spinal fixation methods such as better pull-out strength, greater control in the sagittal, coronal and rotational planes, and fewer vertebral motion...

  • Evaluation of unilateral cage-instrumented fixation for lumbar spine. Ti-Sheng Chang; Jia-Hao Chang; Chien-Shiung Wang; Hung-Yi Chen; Ching-Wei Cheng // Journal of Orthopaedic Surgery & Research;2010, Vol. 5, p86 

    Background: To investigate how unilateral cage-instrumented posterior lumbar interbody fusion (PLIF) affects the three-dimensional flexibility in degenerative disc disease by comparing the biomechanical characteristics of unilateral and bilateral cage-instrumented PLIF. Methods: Twelve motion...

  • The CT and intraoperative observation of pedicel-ossification tunnel in 151 cases of thoracic spinal stenosis from ossification of ligamentum flavum. Zhao, Ying; Xue, Yuan; Shi, Nianke; Zong, Yaqi; Yang, Zhong; He, Dong; Wang, Yi; Ding, Huairong; Li, Zhiyang; Tang, Yanming // European Spine Journal;Jun2014, Vol. 23 Issue 6, p1325 

    Purpose: The aim of this study is to precisely illustrate the pedicle-ossification tunnel (POT)-a spinal cord-free pathway in upper facet joint en bloc resection, which was reported as a comparatively neurological safer decompression surgery for thoracic ossification of ligamentum flavum (OLF)....


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics