Selecting Procedures for Reconstructing the Anterior Column in Thoracolumbar Spine Injuries

Abstract

Traumatic destruction of the anterior column is closely associated with kyphotic and scoliotic deformities. Restoring the spine to its original shape requires a reconstructive procedure that enables the anterior column to withstand compressive forces. The following procedures are employed to achieve this aim: transpedicular spongioplasty according to Daniaux, autologous transplants (tricortical iliac crest bone graft), allogenic transplants, vertebral body replacement cages, and bone cement or ceramics. None of these procedures are, however, capable of reliably preventing postoperative loss of correction. Best results with regard to restoring the sagittal shape of the spine can be achieved by using autologous implants in the form of tricortical iliac crest bone grafts and by means of the vertebral body replacement cage. The type of instrumentation (anterior, posterior, or combined) that is required for reconstructing the anterior column is determined by the type of injury. Bone cement or ceramics, applied within the framework of vertebro-/kyphoplasty, expand the therapeutic spectrum with regard to painful osteoporotic compression fractures.