Additional Vertebral Augmentation with Posterior Instrumentation for Unstable Thoracolumbar Burst Fractures

Publication date: Available online 20 June 2017
Source:Injury
Author(s): Fu-Cheng Kao, Ming-Kai Hsieh, Chia-Wei Yu, Tsung-Ting Tsai, Po-Liang Lai, Chi-Chien Niu, Lih-Huei Chen, Wen-Jer Chen
BackgroundTo investigate the role of vertebral augmentation in kyphosis reduction, vertebral fracture union, and correction loss after surgical management of thoracolumbar burst fracture.DesignRetrospective chart and radiographic review.SettingLevel 1 trauma center.MethodsThe analysis included patients treated between April 2007 and June 2015, who received pedicle-screw-rod distraction and reduction within two days following acute traumatic thoracolumbar burst fracture with a load sharing score >6. Medical records were retrospectively reviewed for data regarding operative details, imaging and laboratory findings, neurological function, and functional outcomes.InterventionNot applicable.Main Outcome MeasuresSagittal index, pain score, loss of correction, and implant failure rate.ResultsNineteen patients were enrolled in this study (mean age, 37.2±13years; age range, 17–62 years; female/male ratio: 10/9). Of the five patients who received only reduction (no augmentation), one underwent revision surgery because of implant failure and pedicle screw backing out. Compared to patients who received only reduction, those who received both reduction and augmentation showed better sagittal alignment after the operation, with better sagittal index immediately postoperatively and during the follow-up (p<0.05).ConclusionsTranspedicular vertebral augmentation with calcium sulfate/phosphate-based bone cement may reinforce thoracolumbar burst fracture stability, partially restore vertebral body height, and reduce pedicle screw bending and movement, thereby preventing early implant failure and late loss of correction, especially in patients with excellent fracture reduction.Level of evidence: Therapeutic level III–IV, retrospective chart review



http://ift.tt/2tMNw2d