Percutaneous fixation and balloon kyphoplasty for the treatment of A3 thoracolumbar fractures

Abstract

Background: Despite a long history of descriptive and clinical series, there is still no consensus in the treatment of traumatic thoracolumbar fractures. It is now widely accepted that percutaneous surgery in thoracolumbar spine trauma management can achieve the same results as conventional treatment but less morbidity but it is still not clear which are the best indications for these minimal invasive procedures.

Methods: Thirty-two adult patients with single type A3 thoracolumbar burst fractures without neurologic deficits were included in this retrospective review of clinical and radiological outcomes after surgical management. All patients underwent combined percutaneous kyphoplasty and short fixation with screws in the vertebral pedicles above and below the fracture. Radiographic evaluation of segmental kyphosis and local kyphotic corrections were made preoperatively, 3 days postoperatively, 12 months post-operatively and at the last follow-up (the mean last follow-up was 41 months post-operatively). Clinical outcomes were determined by SF-36^® Health Survey and Oswestry Disability Index scores at 3-month and 12-month follow-ups.

Results: Clinical assessments suggested good outcomes as early as the third postoperative month. The clinical outcomes were sustained at one year follow-up. At the last follow-up the segmental kyphosis correction and local kyphotic correction were maintained.

Conclusions: Our analysis demonstrates that minimally invasive kyphoplasty and percutaneous short fixation applied to thoracolumbar A3 burst fractures without neurological deficit may achieve results comparable to nonsurgical or open surgical treatment, but with less morbidity and complication, and should be considered as a valid treatment option.

Keywords: Balloon kyphoplasty; Percutaneous fixation; Thoracolumbar burst fractures.

Fig. 1

Preoperative and postoperative radiographs of one patient with type A3.2 fracture. The patient with L1 type A3.2 fracture was treated with kyphoplasty at L1 vertebra and pedicle screw fixation in adjacent vertebrae. A-C, Preoperative transverse views of the L1 vertebra. D and E, Preoperative radiographs. F and G, Postoperative radiographs.

Fig. 2

Follow-up SF-36^® Survey Scores. The mean values for SF-36^® Survey Scores were derived from the 32 patients with type A3 burst fractures and plotted. Black bars and grey bars represent SF-36^® Survey Scores at 3-month and 12-month follow-up, respectively. The pink lines indicate the normal scores for the general Italian population. Error bars indicate standard deviation (SD).