Early efficacy of Jack vertebral dilator kyphoplasty bone grafting combined with minimally invasive fixation for thoracolumbar fractures

Abstract

Objective To investigate the short-term clinical efficacy of Jack vertebral dilator kyphoplasty bone grafting combined with minimally invasive fixation in the treatment of thoracolumbar fracture. Methods A retrospective case series analysis was made on 34 patients with thoracolumbar fracture treated by minimally invasive transpedicular bone grafting and fixation in the injury vertebrae with Jack vertebral dilator from December 2014 to December 2015. There were 20 males and 14 females, and their age was 25-27 years (mean, 46.7 years). According to the AO classification, there were 16 cases of type A1 and 18 type A3. The injured levels were at T11in one case, at T12in 6, at L1 in 15, at L2 in 9 and at L3 in 3. The operation time, blood loss, fluoroscopy frequency, incision length, and postoperative hospital stay duration were recorded. The visual analogue scale (VAS), Oswestry disability index (ODI), height ratio of vertebrae, Cobb angle, and complications were evaluated at follow-up. Results The operation time was (91.2±9.8)minutes, blood loss was (42.4±4.3)ml, incision length was (7.2±0.4)cm, intraoperative fluoroscopy frequency were five, postoperative hospital stay was (3.9±0.5)days, and follow-up time was (13.8±1.7)months. All the patients showed complete healing in the injury vertebra. The VAS was (6.4±0.9)points preoperatively, (4.1±0.8)points, (1.2±0.4)points, and (1.2±0.5)points at 7 days, 3 months and 12 months postoperatively. The ODI was (39.2±2.3)points preoperatively, (24.5±1.9)points, (13.0±3.0)points, and (12.3±2.0)points at 7 days, 3 months and 12 months postoperatively. At postoperative 7 days, the VAS and ODI were significantly decreased compared with those preoperatively (P 0.05). The height ratio of vertebrae was 47.8±12.2 preoperatively, 83.6±4.9, 82.5±4.8, and 81.7±4.7 at 7 days, 3 months and 12 months postoperatively. The Cobb angle was respective (22.4±4.7)°preoperatively, (3.6±2.4)°, (4.6±2.6)°, and (5.0±2.8)°at 7 days, 3 months and 12 months postoperatively. At postoperative 7 days, the height ratio of vertebrae was increased and Cobb angle was decreased significantly compared to those preoperatively (P 0.05). No looseness or breakage of internal fixation was found at follow-up and all patients had fracture union at the last follow-up. Conclusion Jack vertebral dilator kyphoplasty bone grafting combined with minimally invasive fixation is safe and effective for treatment of thoracolumbar fractures, as the procedure can quickly relieve the pain, improve the function disability, effectively maintain the height of the vertebral body and restore the sagittal balance of spine. Key words: Thoracic vertebrae; Lumbar vertebrae; Fracture fixation, internal; Vertebral dilator kyphoplasty