Abstract
BackgroundShort-segment pedicle-screw instrumentation is frequently used to stabilize thoracolumbar burst fractures. A recognized disadvantage of this procedure is recurrent kyphosis from intervertebral disc creep into the fractured central endplate. Balloon Assisted Endplate Reduction (BAER) using Tricalcium Phosphate bone cement (TCP) enables elevation of the centrally depressed endplate. Our objective was to evaluate the bone-tissue response to TCP and to analyse whether BAER using TCP can prevent recurrent kyphosis after removal of the instrumentation.MethodsFourteen patients with traumatic thoracolumbar burst fractures were operated with BAER using TCP in combination with short-segment instrumentation. Nine months after surgery, instrumentation was removed and transpedicular biopsies were taken for histological and histochemical analysis. Roentgenograms pre- and postoperatively and at latest follow-up after removal of the instrumentation were evaluated.ResultsAverage follow-up was 2.6 years. Analysis of the biopsies showed a variable degree of bone remodelling with incorporation of TCP into newly formed bone matrix. No extensive foreign body reactions, inflammation, granulomatous responses or tissue necrosis were observed. Wedge-angle, kyphosis-angle and both the anterior-posterior and central-posterior vertebral body height ratios improved significant postoperatively (p < 0.001). After removal of the instrumentation no significant differences in wedge-angle or height ratios were seen (p = 0.12). The kyphosis-angle increased four degrees (p = 0.01).ConclusionTCP showed good histological osseointegration with no adverse events. TCP can therefore be safely used and could be beneficial in treatment of thoracolumbar burst fractures. BAER with TCP in combination with short-segment instrumentation might reduce recurrence of deformity even after removal of the instrumentation in comparison to short-segment instrumentation alone.Trial registrationThis study is registered at the at the Dutch Trial Registry (NTR3498).
Highlights
Short-segment pedicle-screw instrumentation is frequently used to stabilize thoracolumbar burst fractures
In addition we evaluated if Balloon Assisted Endplate Reduction (BAER) using Tricalcium Phosphate bone cement (TCP) cement in combination with short-segment instrumentation, could prevent recurrent kyphosis after removal of the instrumentation in patients with thoracic- or lumbar burst fractures
Recurrence of deformity after short-segment instrumentation for thoracic- or lumbar burst fractures may result from intervertebral disc creep into the fractured central endplate [6,7,8]
Summary
Short-segment pedicle-screw instrumentation is frequently used to stabilize thoracolumbar burst fractures. A recognized disadvantage of this procedure is recurrent kyphosis from intervertebral disc creep into the fractured central endplate. Treatment objectives after thoracic- and lumbar burst fractures are to stabilize the spine, prevent neurological deterioration, restore sagittal balance, retain as much segmental mobility as possible with the least operative tissue trauma and to mobilize the patient as quickly as possible. Because the posterior instrumentation alone does not provide sufficient support to allow the fractured vertebral body to heal without supplemental load-sharing through anterior column reconstruction This anterior column insufficiency results form collapse of disc space and not from collapse of the fractured vertebral body [4, 5]. Öner et al demonstrated that this collapse of disc space results from creep of the intervertebral disc into the fractured central endplate [6,7,8]
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