Single-Stage Posterior Vertebral Body Resection and Reconstruction Using Expandable Cage for Unstable Mid and Lower Lumbar Burst Fractures

Abstract

Introduction Patients with unstable mid and lower lumbar burst fractures require surgical treatment to relieve pain, address paralysis, and stabilize the spine to prevent further segmental deformity. However, controversy remains regarding the optimal surgical treatment. The purpose of this study is to examine the efficacy and safety of corpectomy and expandable cage placement via a single-stage posterior approach for unstable mid and lower lumbar burst fractures (below the L3). Patients and Methods A total of 11 patients underwent single-stage posterior-only vertebral column resection and vertebral body reconstruction using an expandable cage. Neurologic status was classified using the American Spinal Injury Association (ASIA) Impairment Scale, while functional outcome was analyzed using a visual analog scale (VAS) for back pain. Segmental Cobb angles were measured above and below the fractured vertebral body preoperatively, immediate postoperatively, and at the last follow-up. Results The preoperative neurologic status was ASIA grade E in two patients, grade D in five patients, grade C in two patients, and grade B in two patients. Postoperatively, neurologic stability was demonstrated in three patients (27%), and eight patients (73%) showed improvement in the ASIA grade. The mean preoperative VAS score was 8.3, which decreased to 4.5 postoperatively, and to 1.8 at the final follow-up. The mean preoperative segmental lordotic angle was 9.2 degrees, which increased to 16.9 degrees postoperatively, and decreased to 15.1 degrees at the last follow-up. The mean operating time was 208.8 minutes, and the mean blood loss was 588 mL. Regarding surgical complications, one patient experienced a dural tear and one patient demonstrated cage subsidence. Conclusion The results of this small series suggest the feasibility, efficacy, and safety of this surgical option for unstable mid and lower lumbar burst fractures. This technique from a single posterior approach offers several advantages over traditional anterior or combined approaches using strut graft or nonexpandable implants.