Flexion-distraction injury of the L1 vertebra treated with short-segment posterior fixation and Optimesh

Abstract

We report a patient with a flexion-distraction injury of the L1 vertebra treated with a combination of short-segment posterior fixation and Optimesh (Spineology Inc., St. Paul, MN, USA), a flexible balloon-shaped mesh that is deployed into the fractured vertebra together with allograft. The patient, a 47-year-old man, was admitted after sustaining a motor vehicle accident. Imaging studies showed an L1 compression fracture. The patient had no neurologic deficits and was treated conservatively. However, intense back pain persisted and significant kyphosis was noted when he mobilized. Review of the imaging studies strongly suggested disruption of the posterior spinal ligaments. Surgical intervention was performed to address both restoration of the posterior tension band and anterior column height simultaneously. The combined procedure consisted of short-segment posterior fixation from T12 to L2, and placement of Optimesh filled with allograft into the L1 vertebral body. The anterior column height was restored and spinal alignment was corrected by the procedure, and the patient’s back pain subsided soon after the procedure. The role of minimally invasive procedures for reconstruction of the vertebral column height, including the Optimesh system, in patients with thoracolumbar compression fracture seems promising. However, the long-term efficacy of these new techniques is unknown. It also remains to be seen how the delivery of allograft into the fractured vertebra via Optimesh affects remodeling, and whether the restored vertebral height is maintained.