gms | German Medical Science

Objectives: Traditionally, thoracolumbar split and burst-split fractures have been treated with combined antero-posterior bisegmental fusion procedures. Especially in the lower lumbar spine, such interventions can be invasive and are associated with an increased risk of neurological and vascular complications. This retrospective study aims to determine whether percutaneous stent-kyphoplasty is a viable treatment option for these injuries in terms of efficiency, patient safety and kyphotic angle correction.

Methods: From Sep. 2014 to Sep. 2016, 14 consecutive patients (5 female, mean age 61 years) with 7 thoracolumbar split and 8 burst-split fractures (T11 to L5) of different etiology (9 high vs. 5 low energy traumas) and without neurological symptoms were treated with percutaneous stent-kyphoplasty (SpineJack®). CT and/or MR imaging was performed preoperatively in all patients while radiographs were obtained postoperatively and at every follow-up. The mean follow-up was 4.8 months (range, 1.5 to 14.9 months). All cases were evaluated retrospectively for complications, duration of surgery, length of postoperative stay, and change of radiographic kyphotic angle.

Results: The mean duration of isolated single-level stent-kyphoplasties was 30 minutes (range, 20 to 45 minutes), the mean length of postoperative stay was 3.5 days (range, 2-4 days). Among all 14 patients, there was one case (7 %) of mild segmental hypesthesia/weakness which spontaneously resolved within a few days and one case (7 %) of unilateral radicular pain which subsided after periradicular steroid infiltration. Asymptomatic cement leakage was detected in 4 cases (27 %). Radiologically, the mean local kyphotic angle was seen to improve from 8.0° preoperatively to 5.5° postoperatively (p = 0.01). In most cases, some vertebral body subsidence was noted by the time of the last follow-up visit resulting in a mean kyphotic angle insignificantly different from preoperative measurements (8.1 degrees; p = 0.41).

Conclusion: Stand-alone percutaneous stent-kyphoplasty (SpineJack®) appears to be a safe and expeditious, minimally invasive treatment option for thoracolumbar split or burst-split fractures resulting from both low and high energy accidents; it may be considered an alternative to combined anterior/posterior instrumented bisegmental fusion with its associated surgical morbidity. However, future studies with a larger sample size should investigate to what degree secondary kyphosis can be improved by this procedure in the long term.