Less invasive reduction and fusion of fresh A2 and A3 traumatic L1–L4 fractures with a novel vertebral body augmentation implant and short pedicle screw fixation and fusion

Oct 31, 2013European journal of orthopaedic surgery & traumatology : orthopedie traumatologie

Less invasive repair and fusion of fresh middle lower back fractures using a new bone-support implant with short screw fixation

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Abstract

PMMA leakage occurred in 3 patients (3 vertebrae) during a novel vertebral augmentation technique with PEEK and PMMA.

The hybrid construct restored anterior vertebral body height ratio, posterior vertebral body height ratio, segmental kyphosis, and spinal canal encroachment at an average follow-up of 17 months.
Cement leakage was observed either anteriorly to the fractured vertebral body or to the adjacent disc, but not to the spinal canal.
Two pedicle screws were malpositioned without resulting in neurologic complications.
Significant improvements in pain and functional scores were noted post-operatively.

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The aim of this clinical study was to report on the efficacy in reduction and safety in PMMA leakage of a novel vertebral augmentation technique with PEEK and PMMA, together with pedicle screws in the treatment of fresh vertebral fractures in young adults. Twenty consecutive young adults aged 45 ± 11 years with fresh burst A3/AO or severely compressed A2/AO fractures underwent via a less invasive posterior approach one-staged reduction with a novel augmentation implant and PMMA plus 3-vertebrae pedicle screw fixation and fusion. Radiologic parameters as segmental kyphosis (SKA), anterior (AVBHr) and posterior vertebral body height ratio (PVBHr), spinal canal encroachment (SCE), cement leakage and functional parameters as VAS, SF-36 were measured pre- and post-operatively. Hybrid construct restored AVBHr (P < 0.000), PVBHr (P = 0.02), SKA (P = 0.015), SCE (P = 0.002) without loss of correction at an average follow-up of 17 months. PMMA leakage occurred in 3 patients (3 vertebrae) either anteriorly to the fractured vertebral body or to the adjacent disc, but in no case to the spinal canal. Two pedicle screws were malpositioned (one medially, one laterally to the pedicle at the fracture level) without neurologic sequelae. Solid posterolateral spinal fusion occurred 8-10 months post-operatively. Pre-operative VAS and SF-36 scores improved post-operatively significantly. This study showed that this novel vertebral augmentation technique using PEEK implant and PMMA reduces and stabilizes via less invasive technique A2 and A3 vertebral fractures without loss of correction and leakage to the spinal canal.

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Less invasive reduction and fusion of fresh A2 and A3 traumatic L1–L4 fractures with a novel vertebral body augmentation implant and short pedicle screw fixation and fusion

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