title: Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience.
abstract: To assess the efficacy and feasibility of vertebroplasty and posterior short-segment pedicle screw fixation for the treatment of traumatic lumbar burst fractures. Short-segment pedicle screw instrumentation is a well described technique to reduce and stabilize thoracic and lumbar spine fractures. It is relatively a easy procedure but can only indirectly reduce a fractured vertebral body, and the means of augmenting the anterior column are limited. Hardware failure and a loss of reduction are recognized complications caused by insufficient anterior column support. Patients with traumatic lumbar burst fractures without neurologic deficits were included. After a short segment posterior reduction and fixation, bilateral transpedicular reduction of the endplate was performed using a balloon, and polymethyl methacrylate cement was injected. Pre-operative and post-operative central and anterior heights were assessed with radiographs and MRI. Sixteen patients underwent this procedure, and a substantial reduction of the endplates could be achieved with the technique. All patients recovered uneventfully, and the neurologic examination revealed no deficits. The post-operative radiographs and magnetic resonance images demonstrated a good fracture reduction and filling of the bone defect without unwarranted bone displacement. The central and anterior height of the vertebral body could be restored to 72 and 82% of the estimated intact height, respectively. Complications were cement leakage in three cases without clinical implications and one superficial wound infection. Posterior short-segment pedicle fixation in conjunction with balloon vertebroplasty seems to be a feasible option in the management of lumbar burst fractures, thereby addressing all the three columns through a single approach. Although cement leakage occurred but had no clinical consequences or neurological deficit.
authors.affiliation: Spine Clinic, House No. 60, Haider Colony, Soura, Srinagar, Kashmir, 190011, India. afzalsuhail@hotmail.com.
authors.forename: Suhail
authors.initials: S
authors.lastname: Afzal
authors.affiliation: Spine Clinic, House No. 60, Haider Colony, Soura, Srinagar, Kashmir, 190011, India.
authors.forename: Saleem
authors.initials: S
authors.lastname: Akbar
authors.affiliation: Spine Clinic, House No. 60, Haider Colony, Soura, Srinagar, Kashmir, 190011, India.
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Dhar
mesh_terms: D000058:Accidental Falls; D000063:Accidents, Traffic; D000328:Adult; D001843:Bone Cements / Q000627:therapeutic use; D001863:Bone Screws / Q000592:standards*; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D011859:Radiography; D013117:Spinal Cord Compression / Q000517:prevention & control / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate