Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation.

STUDY DESIGN: Retrospective radiographic review. OBJECTIVE: To determine whether clinical factors or common classification systems can predict the radiologic outcome of short-segment thoracolumbar fracture fixation. SUMMARY OF BACKGROUND DATA: Previous reports have indicated that short-segment thoracolumbar fracture fixation might not be appropriate for highly comminuted fractures or for patients with multiple traumatic injuries. METHODS: We conducted a retrospective radiographic review of 46 thoracolumbar fractures treated with short-segment posterior instrumentation to determine the rate of correction loss and instrumentation failure in relation to the Load Sharing Classification of Spine Fracture system and the AO Classification of Fractures system. No postoperative bracing was used. Patients with multisystem organ trauma and those with isolated injuries were included. RESULTS: An average loss of correction of 7.5 degree was observed. Pedicle screw placement into the fractured vertebra seemed to protect against correction loss: 4 of the 7 patients (57%) in the no intermediate fixation group had >10 degree loss of correction. No relationship was shown between loss of correction and Load Sharing Classification (< or = 6 or > or = 7 points), loss of correction and AO Classification, or loss of correction and level of injury (thoracolumbar junction vs. lower lumbar). CONCLUSIONS: With modern instrumentation and techniques, short-segment thoracolumbar fracture fixation could be used successfully, despite highly comminuted injuries, without anterior column support or supplemental bracing.

Neurologic deficit following percutaneous vertebral stabilization.

STUDY DESIGN: A retrospective review. OBJECTIVE: The purpose of this study is to document a series of cases of neurologic deficit following percutaneous vertebral stabilization, to identify patterns of neurologic injury, and to describe potential methods for avoiding these injuries. SUMMARY OF BACKGROUND DATA: Percutaneous vertebral stabilization procedures, including vertebroplasty and kyphoplasty, have become a widely used for the treatment of osteoporotic vertebral compression fractures, primary and metastatic vertebral tumors, and traumatic burst fractures. Despite an increasing array of indications, there have been few reports of adverse events. Neurologic complications associated with vertebroplasty and kyphoplasty have been described previously as case reports and have generally been considered as infrequent and minor in severity. METHODS: The clinical course of 14 patients with documented loss of neurologic function following percutaneous vertebral cement augmentation was retrospectively reviewed. RESULTS: The average patient age was 74.9 years (range, 46-88 years) with 3 male and 11 female patients. Four patients underwent a vertebroplasty procedure while 10 were treated with kyphoplasty. Six patients developed neurologic deficits acutely (<24 hours of procedure). The remaining 8 patients developed neurologic symptoms at an average of 37.1 days (range, 3-112 days) postprocedure. Neurologic deficits were recorded as ASIA A in 4 patients, ASIA B in 2 patients, ASIA C in 1 patient, and ASIA D in 7 patients. Twelve of 14 patients (85.7%) required revision open surgical intervention for treatment of their neurologic injury. CONCLUSION: Percutaneous vertebroplasty and kyphoplasty have been reported to be safe options for the treatment of painful osteoporotic vertebral fractures. Although complications are infrequent, there remains the potential for catastrophic neurologic injury. Physicians performing these procedures need to be aware of these potential complications and be prepared to respond in an emergent manner (surgically) if a need arises.