Armed Kyphoplasty: An Indirect Central Canal Decompression Technique in Burst Fractures.
- Venier A From the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.) alice.venier@eoc.ch.
- Roccatagliata L Neuroradiology (L.R., M.I., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland.
- Isalberti M Neuroradiology (L.R., M.I., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland.
- Scarone P From the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.).
- Kuhlen DE From the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.).
- Reinert M From the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.).
- Bonaldi G Department of Neuroradiology (G.B.), Papa Giovanni XXIII Hospital, Bergamo, Italy.
- Hirsch JA Department of Neuroradiology (J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
- Cianfoni A Neuroradiology (L.R., M.I., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland.
- 2019-10-26
Published in:
- AJNR. American journal of neuroradiology. - 2019
Aged
Aged, 80 and over
Female
Fracture Fixation, Internal
Fractures, Compression
Humans
Kyphoplasty
Lumbar Vertebrae
Male
Middle Aged
Osteogenesis, Distraction
Retrospective Studies
Spinal Fractures
Stents
Thoracic Vertebrae
Treatment Outcome
English
BACKGROUND AND PURPOSE
Burst fractures are characterized by middle column disruption and may feature posterior wall retropulsion. Indications for treatment remain controversial. Recently introduced vertebral augmentation techniques using intravertebral distraction devices, such as vertebral body stents and SpineJack, could be effective in fracture reduction and fixation and might obtain central canal clearance through ligamentotaxis. This study assesses the results of armed kyphoplasty using vertebral body stents or SpineJack in traumatic, osteoporotic, and neoplastic burst fractures with respect to vertebral body height restoration and correction of posterior wall retropulsion.
MATERIALS AND METHODS
This was a retrospective assessment of 53 burst fractures with posterior wall retropulsion and no neurologic deficit in 51 consecutive patients treated with armed kyphoplasty. Posterior wall retropulsion and vertebral body height were measured on pre- and postprocedural CT. Clinical and radiologic follow-up charts were reviewed.
RESULTS
Armed kyphoplasty was performed as a stand-alone treatment in 43 patients, combined with posterior instrumentation in 8 and laminectomy in 4. Pre-armed kyphoplasty and post-armed kyphoplasty mean posterior wall retropulsion was 5.8 and 4.5 mm, respectively (P < .001), and mean vertebral body height was 10.8 and 16.7 mm, respectively (P < .001). No significant clinical complications occurred. Clinical and radiologic follow-up (1-36 months; mean, 8 months) was available in 39 patients. Three treated levels showed a new fracture during follow-up without neurologic deterioration, and no retreatment was deemed necessary.
CONCLUSIONS
In the treatment of burst fractures with posterior wall retropulsion and no neurologic deficit, armed kyphoplasty yields fracture reduction, internal fixation, and indirect central canal decompression. In selected cases, it might represent a suitable minimally invasive treatment option, stand-alone or in combination with posterior stabilization.
Burst fractures are characterized by middle column disruption and may feature posterior wall retropulsion. Indications for treatment remain controversial. Recently introduced vertebral augmentation techniques using intravertebral distraction devices, such as vertebral body stents and SpineJack, could be effective in fracture reduction and fixation and might obtain central canal clearance through ligamentotaxis. This study assesses the results of armed kyphoplasty using vertebral body stents or SpineJack in traumatic, osteoporotic, and neoplastic burst fractures with respect to vertebral body height restoration and correction of posterior wall retropulsion.
MATERIALS AND METHODS
This was a retrospective assessment of 53 burst fractures with posterior wall retropulsion and no neurologic deficit in 51 consecutive patients treated with armed kyphoplasty. Posterior wall retropulsion and vertebral body height were measured on pre- and postprocedural CT. Clinical and radiologic follow-up charts were reviewed.
RESULTS
Armed kyphoplasty was performed as a stand-alone treatment in 43 patients, combined with posterior instrumentation in 8 and laminectomy in 4. Pre-armed kyphoplasty and post-armed kyphoplasty mean posterior wall retropulsion was 5.8 and 4.5 mm, respectively (P < .001), and mean vertebral body height was 10.8 and 16.7 mm, respectively (P < .001). No significant clinical complications occurred. Clinical and radiologic follow-up (1-36 months; mean, 8 months) was available in 39 patients. Three treated levels showed a new fracture during follow-up without neurologic deterioration, and no retreatment was deemed necessary.
CONCLUSIONS
In the treatment of burst fractures with posterior wall retropulsion and no neurologic deficit, armed kyphoplasty yields fracture reduction, internal fixation, and indirect central canal decompression. In selected cases, it might represent a suitable minimally invasive treatment option, stand-alone or in combination with posterior stabilization.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.3174/ajnr.A6285
- PMID 31649154
- Persistent URL
- https://sonar.ch/global/documents/62777
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