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Research ArticleSpine

Armed Kyphoplasty: An Indirect Central Canal Decompression Technique in Burst Fractures

A. Venier, L. Roccatagliata, M. Isalberti, P. Scarone, D.E. Kuhlen, M. Reinert, G. Bonaldi, J.A. Hirsch and A. Cianfoni
American Journal of Neuroradiology November 2019, 40 (11) 1965-1972; DOI: https://doi.org/10.3174/ajnr.A6285
A. Venier
aFrom the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.)
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L. Roccatagliata
bNeuroradiology (L.R., M.I., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland
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M. Isalberti
bNeuroradiology (L.R., M.I., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland
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P. Scarone
aFrom the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.)
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D.E. Kuhlen
aFrom the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.)
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M. Reinert
aFrom the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.)
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G. Bonaldi
cDepartment of Neuroradiology (G.B.), Papa Giovanni XXIII Hospital, Bergamo, ItalydDepartment of Neurosurgery (G.B.), Clinica Igea, Milan, Italy
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J.A. Hirsch
eDepartment of Neuroradiology (J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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A. Cianfoni
bNeuroradiology (L.R., M.I., A.C.), Neurocenter of Southern Switzerland, Lugano, SwitzerlandfDepartment of Neuroradiology (A.C.), Inselspital, University Hospital of Bern, Bern, Switzerland
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Abstract

BACKGROUND AND PURPOSE: Burst fractures are characterized by middle column disruption and may feature posterior wall retropulsion. Indications for treatment remain controversial. Recently introduced vertebral augmentation techniques using intravertebral distraction devices, such as vertebral body stents and SpineJack, could be effective in fracture reduction and fixation and might obtain central canal clearance through ligamentotaxis. This study assesses the results of armed kyphoplasty using vertebral body stents or SpineJack in traumatic, osteoporotic, and neoplastic burst fractures with respect to vertebral body height restoration and correction of posterior wall retropulsion.

MATERIALS AND METHODS: This was a retrospective assessment of 53 burst fractures with posterior wall retropulsion and no neurologic deficit in 51 consecutive patients treated with armed kyphoplasty. Posterior wall retropulsion and vertebral body height were measured on pre- and postprocedural CT. Clinical and radiologic follow-up charts were reviewed.

RESULTS: Armed kyphoplasty was performed as a stand-alone treatment in 43 patients, combined with posterior instrumentation in 8 and laminectomy in 4. Pre-armed kyphoplasty and post-armed kyphoplasty mean posterior wall retropulsion was 5.8 and 4.5 mm, respectively (P < .001), and mean vertebral body height was 10.8 and 16.7 mm, respectively (P < .001). No significant clinical complications occurred. Clinical and radiologic follow-up (1–36 months; mean, 8 months) was available in 39 patients. Three treated levels showed a new fracture during follow-up without neurologic deterioration, and no retreatment was deemed necessary.

CONCLUSIONS: In the treatment of burst fractures with posterior wall retropulsion and no neurologic deficit, armed kyphoplasty yields fracture reduction, internal fixation, and indirect central canal decompression. In selected cases, it might represent a suitable minimally invasive treatment option, stand-alone or in combination with posterior stabilization.

ABBREVIATIONS:

AKP
armed kyphoplasty
BKP
balloon kyphoplasty
PWR
posterior wall retropulsion
SAIF
Stent-Screw Assisted Internal Fixation
VAS
Visual Analog Scale
VBH
vertebral body height
VBS
vertebral body stenting
SJ
SpineJack
  • © 2019 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 40 (11)
American Journal of Neuroradiology
Vol. 40, Issue 11
1 Nov 2019
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Armed Kyphoplasty: An Indirect Central Canal Decompression Technique in Burst Fractures
A. Venier, L. Roccatagliata, M. Isalberti, P. Scarone, D.E. Kuhlen, M. Reinert, G. Bonaldi, J.A. Hirsch, A. Cianfoni
American Journal of Neuroradiology Nov 2019, 40 (11) 1965-1972; DOI: 10.3174/ajnr.A6285

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Armed Kyphoplasty: An Indirect Central Canal Decompression Technique in Burst Fractures
A. Venier, L. Roccatagliata, M. Isalberti, P. Scarone, D.E. Kuhlen, M. Reinert, G. Bonaldi, J.A. Hirsch, A. Cianfoni
American Journal of Neuroradiology Nov 2019, 40 (11) 1965-1972; DOI: 10.3174/ajnr.A6285
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