Abstract
BackgroundDuring the last few years, an increasing number of unstable thoracolumbar fractures, especially in elderly patients, has been treated by dorsal instrumentation combined with a balloon kyphoplasty. This combination provides additional stabilization to the anterior spinal column without any need for a second ventral approach.Case presentationWe report the case of a 97-year-old male patient with a lumbar burst fracture (type A3-1.1 according to the AO Classification) who presented prolonged neurological deficits of the lower limbs - grade C according to the modified Frankel/ASIA score. After a posterior realignment of the fractured vertebra with an internal screw fixation and after an augmentation with non-absorbable cement in combination with a balloon kyphoplasty, the patient regained his mobility without any neurological restrictions.ConclusionEspecially in older patients, the presented technique of PMMA-augmented pedicle screw instrumentation combined with balloon-assisted kyphoplasty could be an option to address unstable vertebral fractures in “a minor-invasive way”. The standard procedure of a two-step dorsoventral approach could be reduced to a one-step procedure.
Highlights
During the last few years, an increasing number of unstable thoracolumbar fractures, especially in elderly patients, has been treated by dorsal instrumentation combined with a balloon kyphoplasty
Especially in older patients, the presented technique of PMMA-augmented pedicle screw instrumentation combined with balloon-assisted kyphoplasty could be an option to address unstable vertebral fractures in “a minor-invasive way”
Especially in older patients with an osteoporotic bone structure, an integration of absorbable bone cement cannot be expected [14]. This case report describes the safe technique in 97-year old patient with a lumbar burst fracture and neurological deficits, treated by cement-augmented pedicle screw instrumentation and balloon-guided kyphoplasty
Summary
Thoracolumbar burst fractures still are a great challenge to surgeons, especially in elderly patients with osteoporotic bones. The case of a 97-year-old male with a lumbar burst fracture that is presented here, illustrates the use of a dorsal pedicle screw instrumentation in combination with a balloon-assisted kyphoplasty and with additional cement-augmented pedicle screws. To our knowledge, this technique has not yet been reported for a patient of this age. This technique has not yet been reported for a patient of this age For this one-step-procedure with a non-absorbable bone cement augmentation, we decided to provide more stability in a severe osteoporotic bone in order to prevent secondary cutting-out or screw loosening. Author details 1Department of Traumatology, Eberhard Karls Universität Tübingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany. 2Department of Traumatology, Klinikum Rechts der Isar, Technische Universität Muenchen, Ismaninger Strae 22, 80809, Munich, Germany
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