Percutaneous extrapedicular vertebroplasty with expandable intravertebral implant in compression vertebral body fracture in pediatric patient-technical note.

PURPOSE: The aim of the article is to present the new extrapedicular percutaneous technique for posttraumatic vertebral column fracture. METHODS: A 15-year-old boy needed a surgical Th8 posttraumatic vertebral body (VB) compressive fracture reduction due to insufficient conservative treatment and consistent severe clinical symptoms. After 6 months of external Jevett long-roll brace stabilization, progressive sagittal balance disturbance of thoracic kyphosis was measured and persistent clinical symptoms were observed. It was decided to present a surgical technique method allowing to attempt to reduce VB fracture, rebalance the vertebral column (VC) without any motion limitation, and decrease clinical symptoms. The procedure was performed percutaneously from extrapedicular approach with intravertebral implant (Spine Jack®-Vexim™) and cement (Interface®-Vexim™) under fluoroscopic imaging (Ziehm™ 8000®). RESULTS: The whole procedure was uneventful. Now, the child is free from clinical symptoms and the partial reduction of VB fracture was achieved. The patient has been followed for 3 months. In the control CT scans, the VB fracture reduction is stable and no progression of thoracic kyphosis angle is observed. Furthermore since the surgical procedure, the patient is clinical symptom free. CONCLUSION: The extrapedicular percutaneus technique of VB fracture reduction with intravertebral fixation allowed to partially reduce the VB compressive fracture, rebalance the VC without any motion limitation, avoid external long-roll brace, and eliminate clinical symptoms. The procedure is minimally invasive, fast, and clinically effective. However, the technique should be restricted only to carefully selected clinical cases.

Measurement of Vertebral Compression and Kyphosis in the Thoracolumbar and Lumbar Fractures

STUDY DESIGN: A retrospective radiologic study. OBJECTIVES: We wanted to compare the compression ratio and kyphosis of thoracolumbar and lumbar fractures according to the radiologic measuring methods and we wanted to analyze their relationship with the stability of fracture. SUMMARY OF THE LITERATURE REVIEW: There are several methods for measuring the compression ratio and kyphotic angle in thoracolumbar fractures, but no definitive measurements and no different values according to the stability have been established. MATERIALS AND METHODS: From July 2002 to August 2008, the plain films, CT, MRI and medical records of thoracolumbar and lumbar fracture were reviewed. The compression ratio and kyphotic angle were calculated by several different formulas with using the lateral view of the plain X-ray film, the sagittal reconstruction image of CT and the sagittal image of MRI and the results were compared. Each subject was classified according to both McAfee's classification and the TLISS classification. RESULTS: Two hundred forty eight vertebral bodies of 205 thoracolumbar fracture patients were analyzed. The compression ratio according to formula 1, which was calculated as 1-anterior vertebral height/posterior vertebral height, was significantly correlated with Cobb's angle and the local kyphotic angle. There was no significant difference between the Cobb's angle calculated using the lateral X-ray and that using the sagittal view of CT; however, it was significantly less using the sagittal MRI view. The unstable fractures according to McAfee's classification showed a significantly higher compression ratio and kyphotic angle compared to those of the stable fractures. CONCLUSIONS: The compression ratio formula 1 was most significantly correlated with the kyphotic deformity. The unstable fractures showed a mean compression ratio higher than 30%, a mean Cobb's angle of 15degrees and local kyphotic angle of 18degrees. The sagittally reconstructed CT was a useful measuring method for the evaluation of kyphotic deformity, and it was more accurate than that of the plain film.