Crizotinib-induced osteitis mimicking bone metastasis in a stage IV ALK-rearranged NSCLC patient: a case report.

BACKGROUND: Targeted therapies are a standard of care for first-line treatment of Anaplastic lymphoma kinase (ALK)-rearranged non small cell lung cancer (NSCLC). Giving the rapid pace of drug discovery and development in this area, reporting of adverse effects of ALK inhibitors is crucial. Here, we report a case of osteitis induced by an ALK inhibitor mimicking bone metastasis, a previously undescribed side effect of crizotinib. CASE PRESENTATION: A 31-year-old woman with stage IV ALK-rearranged NSCLC presented with back pain after 3 months of crizotinib treatment. Diagnostic work-up showed osteitis on the 4th and 5th thoracic vertebrae, anterior soft tissue infiltration and epiduritis, without any sign of infection. Spinal cord decompression, histological removal and osteosynthesis were performed. Histologic examination showed necrosis with abundant peripheral neutrophils, no microorganism nor malignant cell. Symptoms and Computarized Tomography-abnormalities rapidly diseappeared after crizotinib withdrawal and did not recur after ceritinib onset. CONCLUSIONS: This is the first report of crizotinib-induced osteitis. Crizotinib differs from other ALK inhibitors as it targets other kinases as well, which may have been responsible for the osteitis. Crizotinib can induce rapidly extensive osteitis, which can mimic tumor progression.

Blood loss and perioperative transfusions related to surgery for spinal tumors. Relevance of tranexamic acid.

INTRODUCTION: Tranexamic acid (TXA) has been shown to reduce bleeding. Patients with spinal tumors are fragile and acute anemia may be harmful. Tumor excision surgery is reputed to be hemorrhagic and treatment may increase thromboembolic complications. The aim of this study was to compare blood loss with or without perioperative TXA injection. The transfusion-related and postoperative complications were documents. METHOD: This retrospective analysis of prospectively collected data involved 83 patients with spinal tumors who underwent decompressive surgery associated with bone fixation. Tranexamic acid was used arbitrarily in 36 of them, while the other 47 did not receive TXA. The overall, intraoperative and postoperative blood loss was recorded. Blood loss was reported relative to the number of fixed levels and the number of levels decompressed by laminectomy. Transfusions were quantified in number of red blood cell packets and erythrocyte volume. Postoperative complications were documented. RESULTS: Epidemiological and morphological data were similar between groups. There were no significant differences between the two groups in the overall, intraoperative, and postoperative blood loss. A significant reduction in postoperative bleeding was found in the TXA group when the volume was related to the number of decompressed levels. A significant reduction (P<0.05) in the volume of transfused blood was identified in the treated group. No predictor of blood loss was identified, and no additional complications occurred. CONCLUSION: The efficacy of TXA appears to be moderate during spinal tumor surgery since it does not lead to a reduction in perioperative bleeding. However, a significant reduction in transfusion volume was found without an increase in complications.

Litigation in orthopedic surgery: What can we do to prevent it? Systematic analysis of 126 legal actions involving four university hospitals in France.

INTRODUCTION: Orthopedic surgery produces 20% of medical malpractice claims. However only a few studies have examined the reasons for and consequences of these disputes, and they have usually been limited to a single hospital. This led us to perform a retrospective analysis of the claims at four teaching hospitals in northwestern France. The goals were (1) to describe the circumstances that led to these claims and recommend ways to prevent them, and (2) to describe the conduct of the proceedings and their financial and social outcomes. HYPOTHESIS: A systematic analysis of litigation cases will provide accurate information on the circumstances leading to these claims. METHODS: The study included 126 disputes settled between 2000 and 2010 and related to orthopedic or trauma care given at one of four teaching hospitals in northwestern France. The method of recourse, grounds of the complaint, type of surgical procedure, expert findings and amount of the award were systematically analyzed. RESULTS: Of these 126 cases, 54 (43%) of them were submitted to the French CRCI (regional conciliation and compensation commission), 48 (39%) to the French administrative courts and 51 (41%) were settled amicably. Multiple methods of recourse were used in 21% of cases (n=27/126). The average length of administrative court proceedings was 36.7±27 months [4-102], which was significantly longer than the CRCI proceedings (22.7±17.9 months [3-80]) or out-of-court settlement (23.7±21.5 months [0-52]) (p<0.0001). Damages were sought for medical error or treatment-related risk in 67.5% of the complaints (n=85/126), and for failure to inform in 15.8% of cases (n=20/126). There was a suspected surgical site infection in 79.3% of cases (n=100/126). There were multiple grounds for complaint in 68.3% of cases (n=86/126). Poor communication between the physician and patient was identified in 26.2% of cases (n=33/126). Damages were awarded in 25% of cases (n=31/126), with an average award of €58,303±€91,601 [0-357,970]. CONCLUSION: The primary grounds for legal action are infection-related complications combined with a deterioration in the doctor-patient relationship. Disputes could be prevented by continuing efforts to combat hospital-acquired infections and providing better communications training. LEVEL OF PROOF: IV (retrospective study).

Cervical myelopathy involving os odontoideum and retro-odontoid cyst treated with Harms C1-C2 arthrodesis.

An episode of acute decompensation of cervical myelopathy occurred after an injury without fracture of an os odontoideum associated with a compressive retro-odontoid cyst. The 51-year-old female patient presented Fränkel C, Nurick grade 4 neurological status and pyramid syndrome. The initial MRI demonstrated an intramedullary T2 hyperintense signal in the context of spinal cord narrowing. The retro-odontoid cyst demonstrates atlantoaxial instability related to the os odontoideum. Harms C1-C2 arthrodesis without laminectomy was performed and the cyst disappeared completely. Spinal cord decompression was thus obtained on the MRI taken 3 months later. Neurological recovery was complete and continued at 1 year.

The role of Intraoperative 3D navigation for pelvic bone tumor resection.

UNLABELLED: Interventional 3D analysis is often used for surgery of the spine. The goal of this study was to describe the technique and initial results of intraoperative 3D CT navigation (O-Arm, Medtronic, Louisville, CO, USA) for surgery of the pelvis. Six patients were included, five with primary bone tumors and one with post-traumatic non-union. All CT procedures were completed without modifying the surgical technique, except one case in which the device had to be reinstalled during surgery. The duration of surgery was not increased and lasted for a mean 224minutes (96-380). Recorded radiation was between 450-1125mGrey/cm. All procedures were performed according to the preoperative plan resulting in systematic resection with a safe surgical margin (R0). One surgical site infection occurred. Although these operations could have been performed without 3-D navigation, this technique provided continuous intraoperative control and safety. LEVEL OF EVIDENCE: IV.

Do temperature variations at the bearing surface during gait affect polyethylene wear in Charnley low-friction arthroplasty of the hip? Simulator study comparing UHMWPE and highly cross-linked polyethylene.

INTRODUCTION: There are significant individual variations in the polyethylene (PE) wear of Charnley total hip arthroplasty (THA) in published studies. This could be in part related to variations in hip joint kinematics with abnormal heating at the metal/PE interface. The objectives of our hip simulator experiment were: (1) to measure PE wear as a function of hip kinematics and temperature variations at the interface; (2) to compare ultra-high molecular weight polyethylene (UHMWPE) to latest generation highly cross-linked PE (XLPE). HYPOTHESIS: Our hypothesis was that PE wear is correlated with temperature increases at the interface and thereby hip joint kinematics. MATERIAL AND METHODS: A simulator study was performed with four UHMWPE cups (Initiale™, Amplitude, Valence, France) and two XLPE cups (X3, Stryker, Kalamazoo, Michigan, USA) subjected to 5 million cycles each. The temperature at the femoral head/cup interface was measured every 500 cycles and implant dimensions were measured every 1 million cycles. RESULTS: The average temperature was 42°C for 1Hz and 50°C for 1.5Hz, no matter the type of PE tested. There was a large difference between UHMWPE and XLPE in their roughness, but no temperature variations or wear effects. Femoral head penetration after the first 1 million cycles was 0.18mm for the XLPE and 0.075mm UHMWPE on average. Between 1 and 5 million cycles, the penetration was less than 0.1mm per million cycles, with XLPE being similar to UHMPWE. DISCUSSION: Our study found a significant temperature increase at the bearing interface as a function of frequency. But there was no correlation between temperature variations and PE degradation. However, shear stresses were under-estimated because our simulator could not reproduce abduction and adduction movements. Our hypothesis was not confirmed because PE deformation was not correlated to temperature variations. XLPE was not better than UHMWPE in the particular conditions of this study. Simulator studies are limited because of the lack of standards on cycling and the simulator bath. LEVEL OF EVIDENCE: III-prospective case-control study in vitro.

[Are C2 pedicles always screwable? Calibration and planning with a pedicle-lamina angle]. / Les pédicules de C2 sont-ils toujours vissables ? Calibration et planification selon l'angle pédiculo-lamaire.

INTRODUCTION: Posterior cervical arthrodesis is associated with osteosynthesis. C2 pedicular screwing affords a good bone anchoring but involves neurological and vascular risks. PURPOSE: To determine C2 pedicular screwing feasibility from a large cohort of cervical CT scans. To describe the visible anatomical parameters during a surgical procedure in order to plan and secure it. MATERIALS AND METHODS: Retrospective consecutive series of 100 cervical CT scans was analyzed. Cases with upper cervical fracture were excluded. C2 surgical anatomy was assessed according to maximum length, minimum width and minimum height. Angular parameters were pedicle-transverse angle and sagittal angle. Original pedicle-lamina angle was used as a visible mark during the procedure independent of the patient's position. Pedicular screwing feasibility was evaluated. It was arbitrarily defined by a lower minimum height less than 4mm. RESULTS: Two hundred C2 pedicles were analyzed with 7.5% that were not screwable. Their mean length was 26.2mm, with a mean width of 5.2mm and a mean height of 9.2mm. Mean pedicle-transverse angle was 36.2°, mean sagittal angle was 25.8° and mean pedicle-lamina angle was 81.3°. CONCLUSION: C2 pedicle screwing feasibility is inconstant due to anatomical variability. In fact, 13% of patients have at least one non-screwable pedicle. Preoperative planning is essential to achieve this procedure. A pedicle-lamina angle can be used which remains independent from the patient's position.

Symptomatic compressive pneumocephalus following lumbar decompression surgery.

We report a case of symptomatic postoperative pneumocephalus after lumbar decompression. A 69-year-old man was operated on for a severe lumbar stenosis with a L2-L4 arthrodesis and a spinal decompression. No cerebrospinal fluid leakage was visible but one of the two aspirative drains was accidentally disconnected in recovery room. After 1 day, computed tomography was performed to explore intense lumbar pain and revealed a voluminous pneumorachis. Then, the patient experienced a generalized tonic-clonic seizure. Imaging revealed a voluminous pneumocephalus responsible for a significant space-occupying effect on the frontal lobe. A conservative treatment was initiated, including bed rest, oxygen therapy, neurological monitoring and anti-epileptic therapy. Symptoms gradually improved and he was discharged without any deficit after 10 days. A total radiological regression was noted in 21 days. Prevention of postoperative pneumocephalus should include a systematic repair of iatrogenic dural tear. Even in presence of severe symptomatic manifestations, a conservative treatment is possible.

[Fishtail deformity after a non-displaced supracondylar humeral fracture in childhood: A case report]. / Hypoplasie de la joue latérale de la trochlée à distance d'une fracture supracondylienne de l'humérus non déplacée chez l'enfant : à propos d'un cas.

We report the case of a 13-year-old boy presenting with stiffness and pain in the elbow, which had appeared a few years before consultation. He reported a history of a closed, nondisplaced supracondylar fracture of the humerus 7 years before. Progression was good after orthopedic treatment. X-rays and CT showed a distinctive deformation, called a fishtail deformity, associated with severe arthritic injuries. We recall here that supracondylar fractures of the humerus are common in children and that early reduction decreases the complication rate. However, this case shows that fishtail deformity is a late and serious complication, which may occur after a nondisplaced supracondylar fracture of the humerus, with no severity factors and with good early progression.

Degenerative lumbar spondylolisthesis: cohort of 670 patients, and proposal of a new classification.

Degenerative spondylolisthesis is common in adults. No consensus is available about the analysis or surgical treatment of degenerative spondylolisthesis. In 2013, the French Society for Spine Surgery (Societe francaise de chirurgie du rachis) held a round table discussion to develop a classification system and assess the outcomes of the main surgical treatments. A multicentre study was conducted in nine centres located throughout France and Luxembourg. We established a database on a prospective cohort of 260 patients included between July 2011 and July 2012 and a retrospective cohort of 410 patients included in personal databases between 2009 and 2013. For patients in the prospective cohort clinical assessments were performed before and after surgery using the self-administered functional impact questionnaire AQS, SF12, and Oswestry Disability Index (ODI). Type of treatment and complications were recorded. Antero-posterior and lateral full-length radiographs were used to measure lumbar lordosis (LL), segmental lordosis (SL), pelvic incidence (PI), pelvic tilt (PT), sagittal vertical axis (SVA), and percentage of vertebral slippage. Mean follow-up was 10 months. We started a randomised clinical trial comparing posterior fusion of degenerative spondylolisthesis with versus without an inter-body cage. 60 patients were included, 30 underwent 180° fusion and 30 underwent 360° fusion using an inter-body cage implanted via a transforaminal approach. We evaluated the quality of neural decompression achieved by minimally invasive fusion technique. In a subgroup of 24 patients computed tomography (CT) was performed before and after the procedure and then compared. Mean age was 67 years and 73% of degenerative spondylolisthesis were located at L4-L5 level. The many surgical procedures performed in the prospective cohort were posterior fusion (39%), posterior fusion combined with inter-body fusion (36%), dynamic stabilization (15%), anterior lumbar fusion (8%), and postero-lateral fusion without exogenous material (2%). Peri-operative complications of any severity occurred in 17% of patients. The AQS, ODI and SF12 scores were improved significantly at follow-up. We found no differences in clinical improvements across surgical procedure types. Circumferential fusion (360°) was associated with greater relief of nerve root pain and better lordosis recovery after 1 year compared to postero-lateral fusion (180°). Post-operative CT images showed effective decompression of nervous structures after minimally invasive fusion. Longer follow-up of our patients is needed to assess the stability of the results of the various surgical procedures. Based on a radiological analysis, the authors propose a new classification with five types of degenerative spondylolisthesis: type 1, SL>5° and LL>PI-10°; type 2, SL<5° and LL>PI-10°; type 3, LL25°; and type 5, sagittal imbalance with SVA>4 cm. PROOF LEVEL: IV Observational cohort study. Retrospective review of prospectively collected outcome data.

Sacro-iliac joint arthroscopy for arthrodesis after traumatic dislocation. Cadaver and clinical feasibility study.

BACKGROUND: Sacro-iliac arthrodesis usually requires an extended posterior approach, which is associated with a number of dreaded complications. Here, we assessed the feasibility of arthroscopic exploration of the dislocated sacro-iliac joint. MATERIALS AND METHODS: In the first step of our study, we used ligament section to induce loss of sacro-iliac joint coaptation in a cadaver. We then studied 5 patients with Tile C pelvic ring injuries. Arthroscopy was used to clear the joint of fibrous tissue and to roughen the bone to subchondral level in order to induce sacro-iliac arthrodesis. In addition, posterior fixation was performed using a hinge system or an ilio-sacral screw. RESULTS: The cadaver study confirmed the feasibility of sacro-iliac arthroscopy after disruption of the strong posterior inter-osseous ligament. In the clinical part of the study in 5 patients with Tile C pelvic ring injuries, arthroscopy allowed direct visualisation extending to the anterior part of the joint space. A power burr and synovial knife were introduced to remove the interposed fibrous tissue and to roughen the bone to subchondral level in order to induce joint fusion. In addition, percutaneous or open posterior fixation was performed in all 5 patients. No infectious complications were recorded. DISCUSSION: An arthroscope cannot be introduced into the normal sacro-iliac joint. In contrast, after traumatic sacro-iliac dislocation, arthroscopy can be used to evaluate the intra-articular injuries and to roughen the bone to subchondral level.

[Razemon's lateral digital rotation flap in severe Dupuytren contracture of the fifth finger]. / Le lambeau de rotation latéro-digital de Razemon dans les formes graves de la maladie de Dupuytren du cinquième rayon.

In Dupuytren's disease, correction of severe contracture deformities and excision of dermal lesions are often responsible for palmar skin defects. This study aimed to assess the results of the lateral digital flap described by Razemon. Thirty-seven patients were analysed retrospectively for functional and trophic results. Twelve months of follow-up were at least required. The lack of extension was appreciated through Thomine's coefficient. Subjective patient's opinion was noted about function of fifth finger and hand. The flap trophicity was evaluated through softness, coverage quality and esthetic aspect. In the preoperative period, the average lack of extension was 105°; 89% of the patients were ranked as stages 3 or 4 of Tubiana's classification. At the 12th month, the average Thomine's coefficient was 0.74; 70% of the patients were very satisfied. Two patients exhibited some lack of suppleness and seven a dyschromic scars. The lateral digital rotation flap is a quite simple surgical procedure. It allows satisfactory results corresponding to functional and trophic coverage in severe Dupuytren's contracture involving the fifth finger.

[Lyme arthritis in children: a diagnostic trap]. / Arthrite de Lyme chez l'enfant : un piège diagnostique.

Lyme disease incidence is diverse in France. It is rare in many regions but very frequent in Central and Eastern France. Arthritis is a late manifestation of Lyme disease. In children, the clinical and biological picture often resembles that of septic arthritis and juvenile rheumatoid arthritis, which are more frequent. This explains why diagnosis may be delayed, especially when patient lives in a region of low incidence. We report the case of an 8-year old girl with knee arthritis treated as septic arthritis in a region where Lyme disease is rare. Six days later, clinical and biological worsening suggested that the diagnosis had to be reconsidered. Lyme arthritis was confirmed by serology. Treatment was adapted and the progression was positive. This case reminds us that, in children, Lyme arthritis may look alike septic arthritis or juvenile rheumatoid arthritis and must be considered as a possible diagnosis, even in low-incidence areas.

Early diagnosis of thoracolumbar spine fractures in children. A prospective study.

INTRODUCTION: Early detection of spine fractures in children is difficult because the clinical examination does not always raise worrisome symptoms and the vertebrae are still cartilaginous, and consequently incompletely visualized on routine X-rays. Therefore, diagnosis is often delayed or missed. HYPOTHESIS: The search for a "breath arrest" sensation at the moment of the trauma improves early detection of thoracolumbar spine fractures in children. MATERIALS AND METHODS: This was a prospective monocentric study including all children consulting at the paediatric emergency unit of a single university hospital with a thoracolumbar spine trauma between January 2008 and March 2009. All children had the same care. Pain was quantified when they arrived using the visual analog scale. Clinical examination searched for a "breath arrest" sensation at the moment of the trauma and noted the circumstances of the accident. X-rays and MRI were done in all cases. RESULTS: Fifty children were included with a mean age of 11.4 years. Trauma occurred during games or sports in 94% of the cases. They fell on the back in 72% cases. Twenty-three children (46%) had fractures on the MRI, with a mean number of four fractured vertebrae (range, 1-10). Twenty-one of them (91%) had a "breath arrest" sensation. Fractures were not visualized on X-rays in five cases (22%). Twenty-seven children had no fracture; 19 of them (70%) did not feel a "breath arrest". Fractures were suspected on X-rays in 15 cases (56%). DISCUSSION: The search for a "breath arrest" sensation at the moment of injury improves early detection of thoracolumbar spine fractures in children (Se=87%, Sp=67%, PPV=69%, NPV=86%). When no fracture is apparent on X-rays and no "breath arrest" sensation is expressed by the child, the clinician can be sure there is no fracture (Se=26%, Sp=100%, PPV=100%, NPV=53%). LEVEL OF EVIDENCE: Level III.

Lumbar spinal stenosis: which predictive factors of favorable functional results after decompressive laminectomy?

BACKGROUND AND PURPOSE: Long-term results of decompressive laminectomy in degenerative lumbar stenosis have been studied in only six prospective studies. The objective of our study was to evaluate the functional outcome at long term of patients after decompressive laminectomy in lumbar stenosis and to determine predictive factors of favorable outcome. METHODS: A prospective cohort data were collected by an independent observer five years after decompressive laminectomy for degenerative lumbar stenosis. The endpoint was the assessment of the Beaujon score for functional evaluation. The result was considered as favorable if the Beaujon score increased by at last five points between the preoperative stage and at follow-up examination. Logistic regression was then performed with univariate and multivariate analysis to reveal predictive factors of good long-term outcome (P≤0.05). RESULTS: The preoperative characteristic of our population (n=98) was a mean age of 67.3±8.8 years, a low comorbidity (mean Charlson score=2.8±1.5), overweight status (BMI=29.4±6.3) and the mean Beaujon score was 9.3±3.1. At five years after surgery, the mean Beaujon score became 14.1±4.2. Favorable functional outcome concerned 45.9% of our series. The predictive factor of favorable outcome identified in the univariate analysis the neurological deficit (P=0.05) and in the multivariate analysis the low comorbidity (P=0.01). CONCLUSION: The long-term results of surgical treatment of lumbar spinal stenosis were moderate with an improved outcome in 49.5% of cases in our study. The only independent factor to a favorable outcome was the low comorbidity.

Pneumorachis: a possible source of traumatic cord compression.

The presence of air within the spinal canal secondary to trauma is a rare condition. These rare cases are generally asymptomatic. We report our first case of closed thoracic trauma with pneumorachis associated with neurological disorders. According to a review of the literature and after personal record analysis, neurologic symptoms can be correlated to the occurrence of intraspinal air. Therefore pneumorachis appears as a possible cause of traumatic spinal cord compression. In this particular case, pneumorachis spontaneously resolved and early outcome was favourable.

Odontoid process pathologic fracture in spinal tuberculosis.

Craniovertebral junction tuberculosis is a rare lesion in which treatment remains controversial. Options range from conservative treatment to surgery, independently of any associated neurological threat. We here report the first case of pathologic odontoid fracture in a context of spinal tuberculosis, complicated by unusual neurological evolution. The patient presented with non-contiguous multifocal tuberculosis, of which there have previously been only 6 reported cases.

[Polyostotic fibrous dysplasia of the thoracic spine. A case study and review of the literature]. / Dysplasie fibreuse polyostotique du rachis dorsal. Cas clinique et revue de la littérature.

Polyostotic fibrous dysplasia of the thoracic spine is extremely rare and considered a benign disease. We report the case of a 46-year-old woman admitted to the emergency department for subacute paraplegia. The spinal X-ray showed a spontaneous fracture at the T4-T5 level. The CT scan revealed a tumor infiltration of the vertebral body responsible for lysis. Spinal MRI confirmed the neoplasia also located in the epidural space with spinal cord compression. The patient underwent an emergency laminectomy associated with transpedicular screw fixation between the T2 and T6 levels. At 2 months, she had evolved to a normal gait. In the second session, a transthoracic approach was used for a bone-graft-assisted fusion procedure to achieve long-term stabilization. At 4 years, the bone fusion was excellent and the patient was able to resume socioprofessional activities. The diagnosis of fibrous dysplasia is usually made histologically on surgical biopsy but MRI and CT scan sometimes provide a preliminary indication. Although a consensus for management of this disease has not been achieved, the authors recommend radical removal of all involved tissues accompanied by internal fixation and bone-graft-assisted fusion.

[Treatment of thoracolumbar junction burst fractures (Magerl A3) by balloon kyphoplasty: anatomic study]. / Traitement des burst fractures (Magerl A3) de la charnière thoracolombaire par cyphoplastie à ballonnets: étude anatomique.

PURPOSE OF THE STUDY: Balloon kyphoplasty is a not widely used method for the treatment of vertebral burst fractures with displacement of the posterior wall. The purpose of this study was to measure the posterior height of the vertebral body and the posttraumatic canal surface area before and after balloon kyphoplasty for the treatment of burst fractures (Magerl A3). MATERIAL AND METHODS: This anatomic study was conducted on ten experimental burst fractures of the thoracolumar junction prepared on cadaver specimens. The surface area of the canal and the height of the posterior wall were measured by computed tomography before and after balloon kyphoplasty. These two variables were then compared with search for correlation. RESULTS: The posttraumatic canal surface area increased significantly after kyphoplasty (p=0.02). Gain in posterior height was not significant and there was no correlation between the two variables. Cement leakage into the canal was not observed. DISCUSSION: It is known that balloon kyphoplasty can re-establish anterior height and correct for the posttraumatic kyphosis in patients with compression fractures of osteoporotic vertebrae. The present cadaver study shows that when the posterior wall is displaced posteriorly, balloon expansion does not exaggerate the wall displacement. On the contrary, the posttraumatic canal surface area is increased due to the ligamentotaxis effect. CONCLUSION: Balloon kyphoplasty could be an alternative to posterior instrumentation for burst fractures without associated neurological deficit, even if the posterior wall is damaged. This technique can be used to reduce and stabilize the fracture while sparing the adjacent levels and limiting the risk inherent with an extensive surgical approach.