Stand-alone percutaneous stent-kyphoplasty for thoracolumbar split and burst-split fractures

Abstract

Introduction: Traditionally, thoracolumbar split and burst-split fractures are treated with combined antero-posterior bi-segmental fusion procedures. Especially in the lower lumbar spine, such interventions are invasive and are associated with 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 kyphotic angle correction and patient safety. Methods: From Nov. 2014 to Dec. 2017, 25 consecutive patients (9 female, mean age 58 years) with 8 thoracolumbar split and 17 burst-split fractures (T11 to L5) of different etiology (7 high vs. 18 low energy trauma) 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 each follow-up. The mean follow-up was 176 days (SD 130). All cases were evaluated retrospectively for complications regarding nervous damage, LOS, duration of opioid intake, pain-VAS, return to work time and change of radiographic kyphotic angle. Results: The mean kyphotic angle did not change from 1.1° (SD 9.2°) preoperatively to 1.1° (SD 7.9°) postoperatively. Radiologically, the mean increase of the kyphotic angle between surgery and the last follow-up was 2.65° (SD 4.2°). The mean pain-VAS was reduced to 1.8 postoperatively (SD 2.5, p = 0.03). The mean opioid intake duration was 4 days. Conclusion: SpineJack®-kyphoplasty appears to be a safe and expeditious, minimally invasive treatment option for thoracolumbar split or burst-split fractures. It may be considered as an alternative to combined anterior-posterior instrumented bi-segmental fusion with its associated surgical morbidity.

Keywords

• Spine
• Kyphoplasty
• Vertebroplasty
• Minimally invasive surgery
• Spinal fractures