Transpedicular decompression for painful AO Spine type A1 thoracic and lumbar compression fractures: case series study

Abstract

Objective. To analyze dynamics of vertebrogenic pain syndrome and quality of life after transpedicular decompression in patients with depressed fractures of the thoracic and lumbar spine. Material and Methods. An observational prospective pilot study included 10 patients with AO Spine type A1 fractures of the thoracic and lumbar spine operated on in 2020–2021. All patients underwent transpedicular decompression. Severity of pain syndrome according to VAS, ODI score, and the magnitude of apical kyphosis were studied in the preoperative period and at 3 day, 1, 3, 6 and 12 month postoperative follow-up. Results. The age of patients was 35–70 years (median 46). The ratio of men and women was 1 : 4. By localization, the fractures were distributed as follows: T10 – 1 patient (10 %), T11 – 1 patient (10 %), L2 – 2 patients (20 %), T12 – 3 (30 %) and L1 – 3 patients (30 %). Statistically significant regression of pain syndrome according to VAS from 9.5 (7.3; 10.0) to 2 (1.0; 2.0) scores during the year (χ2 = 35.5, df 4, p < 0.001) was observed. Noteworthy was a rapid regression of the pain syndrome 3 days after decompression from 9.5 (7.3; 10.0) to 4.5 (4.0; 6.0) and a decrease of ODI score and improvement in the quality of life of patients from 69.0 (58.5; 82.0) to 9.0 (4.8; 10.8): χ2 = 36.8, df4, p < 0.001. During the follow-up period, an increase in the Cobb segmental angle from 5.3º°(4.1°; 6.7°) to 9.7°(8.4°; 12.5°) (p = 0.005) was observed in all patients. However, this did not affect the intensity of back pain or the quality of life of patients. Newly occurring fractures, Kümmel’s disease and postoperative complications were not identified. Instrumental diagnostics revealed spontaneous fusion at the fracture level during the first year after transpedicular decompression in all cases. Conclusion. Transpedicular decompression is an effective, safe and pathogenetically substantiated method of treating vertebrogenic pain syndrome associated with spinal fracture.

Keywords

• vertebral fracture
• compression fracture
• decompression
• pain syndrome
• back pain