Percutaneous vertebroplasty for treatment of thoracolumbar spine bursting fracture

doi:10.1016/j.surneu.2003.10.049

Surgical Neurology

Volume 62, Issue 6, December 2004, Pages 494-500

https://doi.org/10.1016/j.surneu.2003.10.049 Get rights and content

Abstract

Objective

Percutaneous vertebroplasty can be very beneficial for patients with vertebral osteoporotic compression fractures. To the best of our knowledge, however, there has been no mention in any literature regarding the use of percutaneous vertebroplasty for the treatment of spinal burst fracture.

Methods

A preliminary study was conducted on 6 patients with traumatic burst fractures of vertebrae treated with percutaneous vertebroplasty starting in June 2000. Fractures involving the anterior and middle columns of the vertebrae and the canal were mildly compressed by the retropulsed bone fragment. However, there was no obvious neurologic deficit in these patients. They initially underwent conservative treatment and thoracolumbar spinal orthosis (TLSO) brace for at least 3 months, but the intractable pain caused patients to be bedridden for prolonged periods of time and limited daily activity. As a result, the patients underwent percutaneous vertebroplasty with polymethylmethacrylate (PMMA) for treatment of spinal burst fractures.

Results

Six male patients (mean age: 38.2) who suffered from burst fractures of vertebrae with disabling back pain refractory to analgesic therapy and TLSO brace were treated in this study. The duration of conservation treatment period was 3.5 months to 8 months (mean: 5.2 months). There was no motility. However, 4 vertebrae (66.7%), on radiographs revealed evidence of PMMA leakage through the endplate fracture site into either the disc space or the paravertebral space, without any evident clinical symptoms. No intracanal leakage was seen, and no patient needed a secondary surgical intervention. Pain decreased from 84.3 ± 5.4 mm at baseline to 34.7 ± 4.4 mm at the third postoperative day, 30.2 ± 5.8 at 3 months and 24 ± 3.5 mm at 12 months. The reduction in pain from baseline to the 3-day and 3 month mark was statistically significant (p < 0.05). The mobility was at least 2 levels of improvement (mean improvement 2.7 points) at 12-months postoperative.

Conclusion

In highly selective patients, percutaneous vertebroplasty can be an alternative method for the treatment of spinal burst fractures and the prevention of complications from major surgical procedures. However, this procedure still has potential risks and should be employed with extreme caution to prevent extravasation of PMMA into the spinal canal.

Section snippets

Methods

Patient selection was limited to those patients with focal, intense, deep pain associated with plain film evidence of a recent vertebral bursting fracture. The patients who had fractures involving the posterior column or had severe neurologic deficits were excluded from this study. Often the pain had extended to the patient's lower back, and the symptoms appeared to be deteriorating. The patients initially experienced difficulty in walking and rising from bed, and later could not tolerate

Patients and results

There were 21 patients (17 males, 4 females) with thoracolumbar spinal burst fractures included in this study within 1.5-years period. The follow-up period was at least 12 months. Thirteen patients (62%) had improved symptoms and signs with conservative treatment and TLSO brace. Two (9.5%) patients had deteriorated neurologic deficit and underwent surgical decompression and reconstruction operations. Six male patients (28.5%) who suffered from burst fractures of vertebrae with disabling back

Discussion

The thoracolumbar junction is a zone between the rigid vertebral column with the associated rib cage and the relatively mobile lumbar vertebrae. Therefore, the most common pathologic process at the thoracolumbar junction is a fracture 4, 7, 19. Our patients with fractured vertebra failure of the end plates and vertebral bodies revealed competent ligaments, which rendered the spine stable. In the Holdsworth classification scheme [10], our patients' fractures were classified as burst compression

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TechniquePercutaneous vertebroplasty for treatment of thoracolumbar spine bursting fracture

Abstract

Objective

Methods

Results

Conclusion

Section snippets

Methods

Patients and results

Discussion

Radio Clin North Am

Percutaneous vertebroplasty for pain relief and spinal stabilization

Spine

Vertebroplasties percutanees. Technique et indication

J Neuroradiol

Percutaneous vertebroplasty for osteolytic metastases and myelomaeffects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up

Radiology

Spinal instability as defined by the three-column concept in acute spinal trauma

Clin Orthop

Transpedicular screw-rod fixation of the lumbar spineoperative technique and outcome in 104 cases

J Neurosurg

A mechanistic classification of thoracolumbar spine fractures

Clin Orthop

Note préliminaire sur le traitement des angiomes vertébraux par vertébroplastie acrylique percutanée

Neurochirurgie

La vertébroplastie acrylique percutanée comme traitement des angiomes vertébraux et des affections dolorigénes et fragilisantes du rachis

Chirurgie

Fractures, dislocations, and fracture-dislocations of the spine

J Bone Joint Surg

Vertebral haemangiomas with spinal cord compressionthe place of preoperative percutaneous vertebroplasty with methyl methacrylate

Neuroradiology

Technique
Percutaneous vertebroplasty for treatment of thoracolumbar spine bursting fracture