Abstract
Expandable intravertebral implants are self-expanding devices applied percutaneously by the posterior transpedicular approach. These devices introduce the concept of anatomical restoration of vertebral body endplates and direct anatomical reduction performed from the interior of the vertebral body with a compression fracture. This paper aims to provide a narrative review on the concept, indications, biomechanical characteristics, as well as functional and radiographic outcomes of the main expandable intravertebral implants currently available, in terms of their application to thoracolumbar spine traumatology. To this end, we performed a search in July 2021 on the MEDLINE/PubMed platform with the words “expandable intravertebral implant”, “armed kyphoplasty”, “Vertebral Body Stenting” or “stentoplasty” and “SpineJack”. The search yielded 144 papers, and of those, we included 15 in this review. We concluded that percutaneous transpedicular posterior access, the ability to reduce vertebral body fractures, particularly of the vertebral endplates and to maintain the vertebral body height, makes the application of expandable intravertebral implants an attractive option in the treatment of thoracolumbar vertebral compression fractures. However, more prospective, randomized, and large-scale blinded studies are still warranted, especially comparative studies between treatments and about the preferential use of an expansive implant over others, in order to gain definitive insights into the effectiveness and indications of each of these devices.
Highlights
BackgroundThe treatment of spine fractures, vertebral body compression fractures, has evolved rapidly over the last 30 years, resulting in considerable changes in indications, techniques, and surgical stents
We present the main current studies regarding the application of expandable intravertebral implants in the context of compression vertebral fractures (Table 3, 4)
The study by Thaler et al verified in 55 osteoporotic vertebral fractures, concerning 27 patients submitted to armed kyphoplasty with VBS®, a mean segmental kyphosis correction of 5.8°, and a vertebral kyphosis correction of 3.5° [48]
Summary
The treatment of spine fractures, vertebral body compression fractures, has evolved rapidly over the last 30 years, resulting in considerable changes in indications, techniques, and surgical stents. It is known that the loss of support in the anterior column, a region that receives 80% of axial loads, will inevitably overload the posterior instrumentation, sometimes resulting in its failure, loss of vertebral body height, local and segmental kyphosis post-traumatic, with clinical and functional repercussions [1,2,3,4]. Minimally invasive techniques for augmenting the fractured vertebral body have gained increasing popularity due to their ability to stabilize the anterior column through a posterior percutaneous approach, allowing for good results in symptomatic relief, in convalescence speed, in functional and life quality indexes, as well as in the restoration of the anatomy and biomechanics of the spine [5,6,7,8,9,10,11]
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