Is the transpedicular bone grafting an effective technique for prevention of kyphosis in thoracolumbar fractures?

Abstract

Study Design: This was an interventional randomized trial. Summary of Background Data: Fractures of the thoracolumbar spine represent 90% of all spine fractures, and the thoracolumbar burst fractures (Type A fractures) are the most common in the spine and important cause of posttraumatic kyphotic deformity. The cause of this problem appears to be the structural and mechanical deficiency of the anterior column following indirect fracture reduction by posterior fixation. Objective: The objective of this study was to evaluate the effects of transpedicular intracorporeal grafting associated with short-segment transpedicular fixation on kyphosis progression in patients with thoracolumbar burst fracture Type A3/A4. Materials and Methods: Fifty-nine consecutive patients with thoracolumbar burst fracture were treated with short-segment transpedicular monoaxial screw fixation. Patients were simply randomized divided into transpedicular grafting (TPG) (n = 35; A3 = 20 and A4 = 15) and non-TPG (n = 24; A3 = 19 and A4 = 5). The average follow-up was 21.1 ± 4.2 (range: 16–26) months for the entire study group: 22.1 ± 4.5 months for the TPG group and 20.2 ± 4.8 months for the non-TPG group (P = 0.49). Results: The global mean kyphosis angle before surgery was 21.93° ±3.92°, with 22.06° ±3.55° in the TPG group and 20.75° ±4.68° for non-TPG; P = 0.93. The mean kyphosis angle at the end of follow-up for the entire study was 9.21° ±8.86°, with 8.70° ±2.11° for TPG and 14.08° ±4.73° for non-TPG, (TPG vs. non-TPG, P = 0.010). No obvious clinical complications in both the groups were documented. Conclusions: Our findings demonstrate that transpedicular bone grafting associated with short-segment fixation in thoracolumbar burst fractures has caused a significant effect on the prevention of kyphosis progression after surgery.