'Armed kyphoplasty' with posterior stabilization avoids corpectomy in complex thoracolumbar spine fractures: a case series.

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  • Additional Information
    • Source:
      Publisher: BMJ Publishing Group Country of Publication: England NLM ID: 101517079 Publication Model: Electronic Cited Medium: Internet ISSN: 1759-8486 (Electronic) Linking ISSN: 17598478 NLM ISO Abbreviation: J Neurointerv Surg Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BMJ Publishing Group, c2009-
    • Subject Terms:
      Spinal Fractures*/surgery ; Spinal Fractures*/diagnostic imaging ; Thoracic Vertebrae*/surgery ; Thoracic Vertebrae*/injuries ; Thoracic Vertebrae*/diagnostic imaging ; Lumbar Vertebrae*/surgery ; Lumbar Vertebrae*/injuries ; Lumbar Vertebrae*/diagnostic imaging ; Kyphoplasty*/methods; Humans ; Female ; Male ; Middle Aged ; Aged ; Adult ; Aged, 80 and over ; Treatment Outcome
    • Abstract:
      Background: Complex thoracolumbar fractures require reduction and stabilization. Posterior instrumentation alone and standard cement augmentation may represent undertreatment, while corpectomy has significant morbidity. In a series of unstable thoracolumbar fractures, we assessed the feasibility, safety, and results of 'armed kyphoplasty' (AKP) and surgical posterior stabilization (PS).
      Methods: A total of 24 consecutive patients were treated with combined AKP and PS. Minimally invasive and open surgery techniques were used for PS. AKP was performed with C-arm or biplane fluoroscopic guidance, and screws were placed under navigation or fluoroscopic guidance. A postoperative CT scan and standing plain films were obtained. Patients were followed up according to clinical standards. Kyphosis correction (measured with regional Cobb angle), pain (measured with the Numeric Rating Scale), neurological status (measured with Frankel grade) were assessed.
      Results: A total of 25 fractures of neoplastic (40%), traumatic (32%), and osteoporotic (28%) nature were treated. Open surgery and minimally invasive techniques were applied in 16/24 and 8/24 patients, respectively. Decompressive laminectomy was performed in 13 cases. No intraprocedural complications occurred. Two patients (8%) died due to underlying disease complications and three complications (12%) required re-intervention (one surgical site infection, one adjacent fracture, and one screw pull-out) in the first month. The mean Cobb angle was 20.14±6.19° before treatment and 11.66±5.24° after treatment (P<0.0001). No re-fractures occurred at the treated levels.
      Conclusions: Combined AKP and PS is feasible and effective in the treatment of complex thoracolumbar fractures of all etiologies. AKP avoided highly invasive corpectomy. Anterior and posterior support ensured stability, preventing implant failure and re-fracture. The complication rate was low compared with more invasive traditional 360° open surgical approaches.
      Competing Interests: Competing interests: None declared.
      (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
    • Contributed Indexing:
      Keywords: Device; Spine; Technique; Trauma; Tumor
    • Publication Date:
      Date Created: 20240123 Date Completed: 20240424 Latest Revision: 20240425
    • Publication Date:
      20250114
    • Accession Number:
      10.1136/jnis-2023-021114
    • Accession Number:
      38262730