Short segment fixation of thoracolumbar burst fractures.

Short segment instrumentation for thoracolumbar fractures or fracture dislocations continues to be controversial. Recently, a load-sharing classification score was developed to help predict failure of posterior instrumented fusion alone used for highly comminuted and kyphotic fractures. Twenty-two patients treated with short-segment posterior instrumentation for thoracolumbar fractures were retrospectively reviewed. Although posterior instrumented fusion was used for fractures with a relatively high load sharing classification score, the load-sharing classification score was not predictive of posterior instrumentation failure. Single-level cephalad instrumentation failed at a higher rate than two-level cephalad instrumentation.

Vertebral osteonecrosis related to intradiscal electrothermal therapy: a case report.

STUDY DESIGN: A case of a patient in whom vertebral osteonecrosis developed after intradiscal electrothermal therapy is reported. OBJECTIVE: To illustrate a potential complication of intradiscal electrothermal therapy and potential strategies to avoid it. SUMMARY OF BACKGROUND DATA: Thermal energy delivered in a controlled fashion directly to the annular wall and disc nucleus has been developed as an alternative to surgical methods for treating internal disc disruption. Although 2-year follow-up data are available, few complications and no vertebral body injury have been reported. METHODS: After intradiscal electrothermal therapy, a patient exhibited MRI changes consistent with osteonecrosis in the adjacent vertebral body. The clinical and radiologic findings are presented, along with a review of the pertinent literature. RESULTS: The magnetic resonance images, the temporal relation of intradiscal therapy, and the patient's clinical symptoms are consistent with focal osteonecrosis of the vertebral body. CONCLUSIONS: This case study highlights a potential complication of intradiscal electrothermal therapy. Catheter placement may expose cortical and cancellous bone to temperatures well within the range reported to induce necrosis. In addition, focal disruption of the endplate may prove to be a relative contraindication for intradiscal electrothermal therapy.