Introduction:Although posterior fixation with ligamentotaxis is the standard treatment method for thoracolumbar burst fracture, inadequate reduction of the upper end plate of the vertebra has often been observed.
Objective:We introduced a novel technique to consider adequate reduction of the upper end plate.
Surgical procedure:The pedicle probe for the cervical spine is inserted within the gap between the end plate and the bony fragment, through the safety triangle that is located laterally to the superior articular process, parallel to the upper end plate. When the tip of the probe reaches the gap, the probe is tilted cranially and inserted into the fragment. Thereafter, the probe is tilted caudally, parallel to the end plate. After anteversion of the fragment is reduced, distraction and implantation are performed.
Subjects and Methods:We performed this procedure on 4 cases of lumbar burst fractures. We evaluated the fracture classifications (AO classification), neurological symptoms and recovery, occupancy rates of the spinal canal by the fragment, and angle of anteversion of the fragment in the 4 cases preoperatively, postoperatively, and at the final follow-up. Moreover, we assessed the complications of this procedure.
Results:All 4 cases were classified as A3. None of the cases had a neurological deficit or complications such as dural injury due to the procedure. The mean occupancy rate of spinal canal improved from 56.5% preoperatively to 33.3% postoperatively. The mean angle of anteversion of the fragment also improved from 27.8°preoperatively to 6.8°postoperatively.
Discussion:Reduction of lumbar burst fracture only through craniocaudal traction causes centralization of the spreading vertebral fragments, and subsequently results in inadequate reduction of the fragment that migrates into the canal due to disruption by other fragments. The main problem is the persistence of anteversion of the fragment that is not spontaneously remodeled. The use of other techniques, such as vertebroplasty and trans-pedicle reduction, does not solve this problem.
In the present report, we describe our novel technique that enables direct reduction of the fragment prior to distraction. The advantage of this technique is that the fragment can be reduced without causing disruption, and thus, it enables adequate reduction of the upper end plate. |