Interbody Fusion in Thoracolumbar Fractures (T11-L2) Using the Percutaneous Dorsolateral Technique

Abstract

Background: The authors' concept of reduction and stabilization of thoracolumbar fractures has become more sophisticated. Depending upon the fracture classification, a posterior transpedicular, an isolated anterior or a combined approach is used. Fractures with a low degree of vertebral body comminution and only one-space disk injury are reduced and stabilized by the transpedicular approach. For reliable anterior interbody fusion, the percutaneous, dorsolateral, fluoroscopically controlled application of hydroxyapatite granules has become the method of choice. To obtain better osteoconductive properties, the granules are inoculated with autologous bone marrow. A special instrument set is available for application. Patients and Methods: In a prospective clinical study, the long-term results after posterior transpedicular stabilization of thoracolumbar spine fractures (T11–L2) were followed-up. Success or failure of the method was shown by the loss of correction of the postinjury kyphosis, measured by the angle β on lateral X-rays. Results: In 66 patients, undergoing the above surgical procedure with application of synthetic hydroxyapatite granules, the loss of correction was measured 6, 12, and 24 months postoperatively. Intrinsic stable devices for transpedicular stabilization were used in all cases. After 6 months an average loss of correction of 1.54° was measured, which amounted to 3.05° after 12 months and to 4.13° after 2 years. These values proved to be better than the results of an earlier study, in which we used the same technique, but with autologous and/or allogeneic bone grafts (2.49° after 6 months, 6.30° after 12 months). The loss of correction 1 year after surgery was statistically significantly greater in the group of bone graft recipients compared to the group treated with bioceramic granules (p < 0.001, Mann-Whitney U-test). 6 months after surgery, no statistical significance was observed. Conclusions: The results imply that 1 year postoperatively, the percutaneous, dorsolateral interbody fusion technique with hydroxyapatite granules after transpedicular stabilization shows better results than a similar procedure with interbody fusion technique using bone grafts.