Kyphoplasty-augmented short-segment pedicle screw fixation of traumatic lumbar burst fractures: initial clinical experience and literature review

Abstract

Surgical intervention for thoracolumbar burst fractures is indicated for patients with neurological deficits and/or evidence of severe spinal instability. The goals of surgery are decompression, deformity correction, and stabilization. Nevertheless, the optimal surgical strategy to achieve these goals remains a subject of debate. Short-segment pedicle screw fixation is associated with a 20 to 50% incidence of pedicle screw failure and progressive spinal deformity. Initial biomechanical and clinical studies have shown that reinforcement of short-segment pedicle screw fixation with vertebroplasty improves spinal stability and decreases instrument failure rates. In this study, the authors describe their initial clinical experience with kyphoplasty used to augment short-segment pedicle screw fixation of traumatic lumbar burst fractures. Five patients with traumatic burst fractures of the lumbar spine were included in this retrospective review of patients treated for this disorder at the University of California, San Diego and the University of California, San Francisco between 2002 and 2004. All patients underwent transpedicular kyphoplasty and short-segment pedicle screw fixation. The mean follow-up period was 10.6 months (range 6-18 months). All patients underwent short-segment pedicle screw fixation reinforced with polymethyl methacrylate kyphoplasty. The preoperative, postoperative, and follow-up plain x-ray films were evaluated. Radiographic analysis included measurements of kyphotic angulation, anterior vertebral body height, and evidence of bone fusion. Clinical evaluation was performed postoperatively and at follow-up review. Based on the authors' initial experience, kyphoplasty supplementation may improve the long-term integrity of short-segment pedicle screw constructs and allow for improved rates of fusion and better clinical outcomes in patients with traumatic lumbar burst fractures.