TY  - JOUR
T1  - Thoracolumbar Burst Fractures Treated with Posterior Decompression and Pedicle Screw Instrumentation Supplemented with Balloon-Assisted Vertebroplasty and Calcium Phosphate ReconstructionSurgical Technique
AU  - Marco, Rex A.W.
AU  - Meyer, B. Christoph
AU  - Kushwaha, Vivek P.
Y1  - 2010/03/01
N1  - 10.2106/JBJS.I.01236
JO  - The Journal of Bone & Joint Surgery
SP  - 67
EP  - 76
VL  - 92
IS  - Supplement_1_Part_1
N2  - BACKGROUND: 
  The treatment of unstable thoracolumbar burst fractures with short-segment posterior spinal instrumentation without anterior column reconstruction is associated with a high rate of screw breakage and progressive loss of reduction. The purpose of the present study was to evaluate the functional, neurologic, and radiographic results following transpedicular, balloon-assisted fracture reduction with anterior column reconstruction with use of calcium phosphate bone cement combined with short-segment posterior instrumentation and a laminectomy.METHODS: 
  A consecutive series of thirty-eight patients with an unstable thoracolumbar burst fracture with or without neurologic deficit were managed with transpedicular, balloon-assisted fracture reduction, calcium phosphate bone cement reconstruction, and short-segment spinal instrumentation from 2002 to 2005. Twenty-eight of the thirty-eight patients were followed for a minimum of two years. Demographic data, neurologic function, segmental kyphosis, the fracture severity score, canal compromise, the Short Form-36 score, the Oswestry Disability Index score, and treatment-related complications were evaluated prospectively.RESULTS: 
  All thirteen patients with incomplete neurologic deficits had improvement by at least one Frankel grade. The mean kyphotic angulation improved from 17° preoperatively to 7° at the time of the latest follow-up, and the loss of vertebral body height improved from a mean of 42% preoperatively to 14% at the time of the latest follow-up. Screw breakage occurred in two patients, and pseudarthrosis occurred in one patient.CONCLUSIONS: 
  The present study demonstrates that excellent reduction of unstable thoracolumbar burst fractures with and without associated neurologic deficits can be maintained with use of short-segment instrumentation and a transpedicular balloon-assisted reduction combined with anterior column reconstruction with calcium phosphate bone cement performed through a single posterior incision. The resultant circumferential stabilization combined with a decompressive laminectomy led to maintained or improved neurologic function in all patients with neurologic deficits, with a low rate of instrumentation failure and loss of correction.LEVEL OF EVIDENCE: 
  Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.ORIGINAL ABSTRACT CITATION: 
  "Thoracolumbar Burst Fractures Treated with Posterior Decompression and Pedicle Screw Instrumentation Supplemented with Balloon-Assisted Vertebroplasty and Calcium Phosphate Reconstruction" (2009;91:20-8).
SN  - 0021-9355
M3  - doi: 10.2106/JBJS.I.01236
UR  - http://dx.doi.org/10.2106/JBJS.I.01236
ER  -