Balloon vertebroplasty in combination with pedicle screw instrumentation: a novel technique to treat thoracic and lumbar burst fractures.

STUDY DESIGN

Clinical trial (phase II).

OBJECTIVES

To assess the feasibility and safety of balloon vertebroplasty after posterior short-segment reduction and fixation for the treatment of traumatic burst fractures.

SUMMARY OF BACKGROUND DATA

Hardware failure and loss of reduction after posterior short-segment instrumentation are complications caused by insufficiency of anterior column support. This is due to migration of disc tissue through the endplate into the fractured vertebral body that cannot be restored with posterior instrumentation.

METHODS

Patients with traumatic thoracolumbar burst fractures without neurologic deficits were included. After posterior reduction and fixation, bilateral transpedicular balloon reduction of the endplate was performed, and calcium phosphate cement was injected. Preoperative and postoperative Cobb angle and central and anterior height were assessed with radiographs and MRI.

RESULTS

Twenty patients underwent surgery without technical difficulties, and a substantial reduction of the endplates could be achieved with the technique. All patients recovered uneventfully, and the neurologic examination revealed no deficits. The postoperative radiographs and magnetic resonance images demonstrated a good fracture reduction and filling of the bone defect without unwarranted bone displacement. The central and anterior height of the vertebral body could be restored to 78 and 91% of the estimated intact height, respectively. Complications were cement leakage in five cases without clinical implications and one wound hematoma.

CONCLUSIONS

Transpedicular balloon vertebroplasty for the direct restoration of burst fractures seems feasible in combination with posterior instrumentation. Cement leakage occurred but had no clinical consequences.