gms | German Medical Science

Objective: Different types of injuries can lead to spinal instability, which could be treated by stabilization of the affected segment using posterior spinal instrumentation with pedicle screws. In cases of fractured vertebral body, many spine surgeons avoid the inclusion of the fractured vertebra in the fixation construct. In this abstract, we want to enlighten this surgical behavior.

Methods: In general anaesthesia, the pedicles of the fractured vertebral body were initially localized using biplane fluoroscopic control. The probing of the pedicles was performed via Jamshidi needle followed by inserting 1.6 mm K-wire down the Jamshidi needle into the pedicle depending on biplane fluoroscopy. After transpedicular intracorporeal positioning of the K-wires, intraoperative 3D scan with an isocentric mobile C-arm was performed keeping the sterile conditions of the surgical field unaffected; position and angulation of the K-wires were evaluated and the appropriate screw length and diameter were measured. Afterwards, self-tapping, cannulated screws were inserted using biplane fluoroscopic control.

Results: Seven patients were treated involving the pedicles of the injured vertebra in the fixation unit. None of them had any complication related to the performed operative technique and the postoperative course was eventless in all cases. After a follow up period of 12 months, the control radiographs showed no loosening signs and the clinical examinations were very proper with total relief of lower back pain.

Conclusion: Especially in cases in which the facet joints and segmental ligaments are injured, as well as when a spinal canal decompression has to be performed, the additional fixation of the pedicles of the harmed vertebrae could play an important role in resisting posterior shear and decreasing lower back pain. Furthermore, we suggest that the additional fixation of the pedicle of the fractured vertebra could increase the rotational stability of the fractured segment. An important issue missed yet, is the direct comparison between neglecting the pedicle of the fractured vertebra and involving it in the fixation construct. Overall, evidence is insufficient to inform the benefit or disadvantage of those different methods. However, in the absence of robust evidence to support our hypothetic point of view, it is important to factor in the possible advantage of involving the fractured vertebra into the decision of whether to use this technique or not.

Figure 1 [Fig. 1]