Cement augmentation techniques in traumatic thoracolumbar spine fractures.
METHODS
Review of human cadaveric and in vivo animal studies and clinical trial.


OBJECTIVE
To develop less invasive surgical techniques for reconstruction of the anterior column in thoracolumbar fractures.


BACKGROUND
Persistent central endplate depression can cause anterior column insufficiency after posterior surgery for traumatic thoracolumbar fractures. Reduction of the central endplate followed by intravertebral cement augmentation could restore weight-bearing capacity.


METHODS
In human cadaveric burst fracture models, balloon-assisted endplate reduction (BAER) and vertebroplasty techniques have been investigated in terms of their safety and biomechanical properties. The histologic properties of different cement polymers were studied in an animal vertebral body and endplate defect model. In addition, the clinical outcome of percutaneous cement augmentation in the setting of a burst fracture examining the BAER technique and vertebroplasty with adjunctive posterior pedicle screw fixation is reviewed.


RESULTS
These techniques have proven to be safe and effective, although cement leakage outside the confines of the vertebral body may occur. Calcium phosphate cements are preferable over methylmethacrylate because of their in vivo histologic properties. Using the BAER technique and posterior pedicular fixation, anterior vertebral height restoration is possible. Following balloon removal, some loss of fracture height restoration is observed. Further loss of vertebral height reduction was not observed following cement curing clinically.


CONCLUSIONS
These studies show that less invasive anterior vertebral reconstruction using percutaneous cement augmentation techniques is feasible following traumatic vertebral fractures.
Oner
F Cumhur
FC
Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands. f.c.oner@umcutrecht.nl
Verlaan
Jorrit-Jan
JJ
Verbout
Abraham J
AJ
Dhert
Wouter J A
WJ