Abstract
Background A collapsed nonhealed vertebral fracture with endplate destruction is a challenging injury to address, as there is no single definitive treatment. We present two cases using an innovative transforaminal grafting technique to treat these patients. Case Presentation. Case 1: a 72-year-old woman had nonunion of an L1 compression fracture with destruction of both endplates. T12/L1 and L1/L2 transforaminal debridement and impaction of bone graft were performed followed by posterior instrumentation. At three years follow-up, the fusion mass between T12/L1 and L1/L2 was solid and the patient had minimal pain. Case 2: a 62-year-old woman had nonunion of an L1 burst fracture with destruction of the lower endplate. Hemilaminectomy and transforaminal interbody impaction of bone graft was performed. At three years follow-up, the patient had no back pain and a solid fusion. In both cases, local kyphosis was corrected and fusion obtained. Conclusions Collapsed nonhealed vertebral body fractures combined with endplate destruction can be successfully treated with a one-step posterior surgery consisting of transforaminal debridement and impaction of bone graft in combination with posterior pedicle instrumentation.
Highlights
A collapsed nonhealed vertebral fracture with endplate destruction is a challenging injury to address, as there is no single definitive treatment
The transpedicular bone grafting technique was developed for burst fractures [6, 7], it is not uncommon for interbody fusions to fail after these procedures [8]
If the transforaminal route is taken, the disc space can be more prepared, and bone graft can be directly impacted into the void created by endplate destruction and disc space, resulting in better anterior support and interbody fusion
Summary
A collapsed nonhealed vertebral fracture with endplate destruction is a challenging problem [1], as there is no single definitive treatment for this type of injury. The transpedicular bone grafting technique was developed for burst fractures [6, 7], it is not uncommon for interbody fusions to fail after these procedures [8]. If the transforaminal route is taken, the disc space can be more prepared, and bone graft can be directly impacted into the void created by endplate destruction and disc space, resulting in better anterior support and interbody fusion. We present two cases of collapsed nonhealed vertebral fractures with endplate destruction at the thoracolumbar junction that were treated using transforaminal interbody impaction of allograft. This the first report of this technique to treat collapsed nonhealed vertebral fractures with endplate destruction
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