Vertebroplasty in combination with pedicle screw instrumentation: a new trend in traumatic thoracolumbar fractures

The purpose of the present study was to demonstrate the feasibility and effectiveness of vertebroplasty with polymethyl methacrylate [PMMA], in combination with posterior short-segment reduction and fixation in patients with traumatic thoracolumbar fractures especially with failure of the anterior spinal column to reduce the incidence of construct failure and avoid supplementary anterior approach. Selected fifteen patients with unstable traumatic thoracolumbar fractures with incomplete neurologic deficits were included in this prospective study. They had undergone a surgery for posterior short-segment instrumentation combined with conventional transpedicular vertebroplasty. Polymethyl methacrylate was used to restore the height of anterior column. For vertebroplasty simple instruments were used. The pre and postoperative clinical assessment of the patients in this study was according to Frankel clinical grading. In all patients computed tomography [CT] spine with 3D reconstructions and occasionally magnetic resonance imaging studies were used for initial and follow-up radiological assessment beside the plain X-ray films. The mean follow-up period was one year. The postoperative radiographs and CT scans with 3D reconstruction demonstrated a good reduction of the fractures and restoration of the anterior height of the vertebral body in all patients. The anterior height of the vertebral body could be restored up to 70 - 90% of the estimated intact height. No patients showed construct failure during the follow-up period. Complications included, cement leakage in eleven cases; one patient developed additional neurological deficit. Transpedicular conventional vertebroplasty is a suitable technique to maintain the restored height of collapsed anterior column, when used in combination with posterior instrumentation; it can be effective and sufficient in management of traumatic thoracolumbar fractures to reduce the construct failure resulting from compromised anterior column