Treatment of thoracic or lumbar burst fractures with Balloon Assisted Endplate Reduction using Tricalcium Phosphate cement: histological and radiological evaluation

Oct 12, 2017BMC musculoskeletal disorders

Treatment of Mid-Back or Lower-Back Burst Fractures Using Balloon-Assisted Bone Support with Tricalcium Phosphate: Tissue and Imaging Assessment

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Abstract

Average follow-up was 2.6 years, revealing improvements in spinal alignment after treatment.

Histological analysis indicated variable bone remodeling with Tricalcium Phosphate (TCP) integration into new bone.
No significant adverse reactions such as inflammation or tissue necrosis were observed.
Postoperative evaluations showed significant improvements in wedge-angle, kyphosis-angle, and vertebral body height ratios (p < 0.001).
After instrumentation removal, the kyphosis-angle increased by four degrees (p = 0.01), but no significant differences in wedge-angle or height ratios were noted (p = 0.12).
TCP may be safely used in the treatment of thoracolumbar burst fractures and could help reduce deformity recurrence.

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BACKGROUND: Short-segment pedicle-screw instrumentation is frequently used to stabilize thoracolumbar burst fractures. A recognized disadvantage of this procedure is recurrent kyphosis from intervertebral disc creep into the fractured central endplate. Balloon Assisted Endplate Reduction (BAER) using Tricalcium Phosphate bone cement (TCP) enables elevation of the centrally depressed endplate. Our objective was to evaluate the bone-tissue response to TCP and to analyse whether BAER using TCP can prevent recurrent kyphosis after removal of the instrumentation.

METHODS: Fourteen patients with traumatic thoracolumbar burst fractures were operated with BAER using TCP in combination with short-segment instrumentation. Nine months after surgery, instrumentation was removed and transpedicular biopsies were taken for histological and histochemical analysis. Roentgenograms pre- and postoperatively and at latest follow-up after removal of the instrumentation were evaluated.

RESULTS: Average follow-up was 2.6 years. Analysis of the biopsies showed a variable degree of bone remodelling with incorporation of TCP into newly formed bone matrix. No extensive foreign body reactions, inflammation, granulomatous responses or tissue necrosis were observed. Wedge-angle, kyphosis-angle and both the anterior-posterior and central-posterior vertebral body height ratios improved significant postoperatively (p < 0.001). After removal of the instrumentation no significant differences in wedge-angle or height ratios were seen (p = 0.12). The kyphosis-angle increased four degrees (p = 0.01).

CONCLUSION: TCP showed good histological osseointegration with no adverse events. TCP can therefore be safely used and could be beneficial in treatment of thoracolumbar burst fractures. BAER with TCP in combination with short-segment instrumentation might reduce recurrence of deformity even after removal of the instrumentation in comparison to short-segment instrumentation alone.

TRIAL REGISTRATION: This study is registered at the at the Dutch Trial Registry (NTR3498).

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Treatment of thoracic or lumbar burst fractures with Balloon Assisted Endplate Reduction using Tricalcium Phosphate cement: histological and radiological evaluation

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