Abstract
PurposeIn management of traumatic thoracolumbar burst fractures, short-segment pedicle screw fixation with balloon-assisted endplate reduction (BAER) and cement injection is a safe, feasible, and effective technique to maintain radiological alignment with minimum spinal segments involved. However, 20% of patients report daily discomfort despite good spinal alignment and fusion after this technique. This study provides clinical, radiological, and patient-reported outcomes after a minimum 13 years of follow-up.MethodsEighteen patients were invited at the outpatient clinic for clinical/radiological examinations. The cohort (originally 20 patients) was treated 13–14 years earlier with pedicle screw fixation, BAER, and cement injection for traumatic thoracolumbar burst fractures. Patient-reported outcome measures were obtained at time of examinations. Current data were compared with data obtained at 6 years of follow-up.ResultsSeventeen patients (median age 50; range 32–80) cooperated. No/minimal back pain was reported by 15 patients, and 12 patients returned to their previous heavy labor work. Median visual analog score of health (80%; 50–100%) was similar to results at 6 years (80%; 60–100% p = 0.259). An Oswestry Disability Index score of less than 20% (reflecting minimal disability) was reported by 14 patients, compared with 15 patients at 6 years of follow-up. No significant differences were found in wedge or Cobb angle between the time points. Intravertebral cement resorption was not observed.ConclusionResults from this study suggest that, 13 years after pedicle screw fixation with BAER and cement injection for traumatic thoracolumbar burst fractures, functional performance, pain and radiological outcomes of the current cohort were stable or had slightly improved.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
Traumatic thoracolumbar burst fractures (AO type A3/ A4, previously A3.1 and A3.3) are the result of sudden forceful axial compression of the spine [1]
The aim of the current study was to present the longerterm results by assessing clinical, patient-reported, and radiological outcomes at least 13 years after posterior pedicle screw fixation combined with transpedicular Balloon-assisted endplate reduction (BAER) and subsequent intravertebral calcium phosphate cement (CPC) injection for traumatic thoracolumbar fractures
The other Patient-reported outcome measurements (PROMs) were asked during the visit
Summary
Traumatic thoracolumbar burst fractures (AO type A3/ A4, previously A3.1 and A3.3) are the result of sudden forceful axial compression of the spine [1]. Balloon-assisted endplate reduction (BAER) with injection of an intravertebral bone void filler, for example, calcium phosphate cement (CPC), has been developed as an adjunct to posterior pedicle screw fixation to prevent intrusion of the intervertebral disc through the fractured endplates into the vertebral body by restoring the anatomical boundaries of the adjacent disc space(s) [5, 6] The intention of this procedure is to increase the load-bearing capacity of the anterior column, thereby limiting the risk of implant failure and subsequent loss of spinal alignment, while minimizing the number of segments necessary for sufficient posterior fixation [1, 7]. A recent study reporting on the mid-term follow-up of this technique demonstrated satisfactory clinical and radiological outcomes with a low prevalence of secondary surgical procedures [6]
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