title: Transpedicular hydroxyapatite grafting with indirect reduction for thoracolumbar burst fractures with neurological deficit: A prospective study.
abstract: BACKGROUND
  The major problem after posterior correction and instrumentation in the treatment of thoracolumbar burst fractures is failure to support the anterior spinal column leading to loss of correction of kyphosis and hardware breakage. We conducted a prospective consecutive series to evaluate the outcome of the management of acute thoracolumbar burst fractures by transpedicular hydroxyapatite (HA) grafting following indirect reduction and pedicle screw fixation.
  
  
  METHODS
  Eighteen consecutive patients who had thoracolumbar burst fractures and associated incomplete neurological deficit were operatively treated within four days of admission. Following indirect reduction and pedicle screw fixation, transpedicular intracorporeal HA grafting to the fractured vertebrae was performed. Mean operative time was 125 min and mean blood loss was 150 ml. Their implants were removed within one year and were prospectively followed for at least two years.
  
  
  RESULTS
  The neurological function of all 18 patients improved by at least one ASIA grade, with nine (50%) patients demonstrating complete neurological recovery. Sagittal alignment was improved from a mean preoperative kyphosis of 17°to -2°(lordosis) by operation, but was found to have slightly deteriorated to 1° at final followup observation. The CT images demonstrated a mean spinal canal narrowing preoperatively, immediate postoperative and at final followup of 60%, 22% and 11%, respectively. There were no instances of hardware failure. No patient reported severe pain or needed daily dosages of analgesics at the final followup. The two-year postoperative MRI demonstrated an increase of one grade in disc degeneration (n = 17) at the disc above and in 11 patients below the fractured vertebra. At the final followup, flexion-extension radiographs revealed that a median range of motion was 4, 6 and 34 degrees at the cranial segment of the fractured vertebra, caudal segment and L1-S1, respectively. Bone formation by osteoconduction in HA granules was unclear, but final radiographs showed healed fractures.
  
  
  CONCLUSIONS
  Posterior indirect reduction, transpedicular HA grafting and pedicle screw fixation could prevent the development of kyphosis and should lead to reliable neurological improvement in patients with incomplete neurological deficit. This technique does not require fusion to a segment, thereby preserves thoracolumbar motion.
authors.affiliation: Department of Orthopedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara-city, Chiba 299-0111, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Toyone
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ozawa
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Wada
authors.forename: Koya
authors.initials: K
authors.lastname: Kamikawa
authors.forename: Atsuya
authors.initials: A
authors.lastname: Watanabe
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
authors.forename: Keisuke
authors.initials: K
authors.lastname: Matsuki
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Shiboi
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Ochiai
authors.forename: Tadashi
authors.initials: T
authors.lastname: Tanaka