Re-expansion and Stabilization of Vertebra Plana Fractures Using Bilateral SpineJack® Implants.

David M Joyce,Michelle Granville,Robert E Jacobson

doi:10.7759/cureus.13839

Abstract

The surgical treatment of osteoporotic vertebral fractures with greater than 70% collapse, known as "Vertebra Plana (VP)" has been controversial. Originally VP was a considered a contraindication to vertebroplasty or kyphoplasty because of presumed difficulty of entering the collapsed vertebra as well as obtaining significant re-expansion or correct associated sagittal kyphosis. In some cases, multilevel pedicle screw fixation with or without attempts to correct the collapse is still performed to correct the kyphosis or prevent progression. With experience it was clear that the pedicle could be accessed and VP could be treated without added risk of epidural leak of cement or epidural extravasation. Now, with the introduction of newer third-generation intraspinal expansion devices that are larger and need to be placed bilaterally, their use in cases of VP was again an issue since VP cases were excluded from the original multicenter studies used for worldwide approval. This report reviews six cases of VP treated with bilateral SpineJack® implants (Stryker Corp, Kalamazoo, Michigan, USA) demonstrating it is not only feasible to place these larger size implants but achieve significant reconstitution of vertebral height as well as correction of the kyphotic deformity.

Highlights

The surgical treatment of osteoporotic vertebral fractures with greater than 70% collapse, known as "Vertebra Plana (VP)" has been controversial
This report reviews six cases of VP treated with bilateral SpineJack® implants (Stryker Corp, Kalamazoo, Michigan, USA) demonstrating it is feasible to place these larger size implants but achieve significant reconstitution of vertebral height as well as correction of the kyphotic deformity
While VP has been considered a contraindication in the past for vertebral augmentation and especially for VP, we have shown it was possible to successfully place a vertebroplasty or kyphoplasty cannula as well as larger SJ cannulas in all VP without complications

Summary

Introduction

The surgical treatment of osteoporotic vertebral fractures, when greater than 70% collapse, commonly known as “Vertebra Plana” (VP), has been controversial. It was felt that such severe vertebral collapse could not be treated with either vertebroplasty or balloon kyphoplasty because of the difficulty of entering the collapsed vertebra, reducing posterior vertebral endplate fragments, or obtaining and maintaining significant re-expansion, as well as difficulty in correction of frequently associated sagittal kyphosis [1]. More recent studies demonstrated that the pedicle and collapsed vertebrae could be accessed using either a lateral or transpedicular approach for simple vertebroplasty of kyphoplasty; it was difficult to restore vertebral height or correct kyphosis [5,6]. This report reviews six cases of VP treated with bilateral SJ implants These cases show it is feasible to place these larger implants bilaterally in VP cases and that these implants provide significant lasting vertebral height reconstitution and correction of the kyphotic deformity

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Discussion

Conclusion