title: Percutaneous augmented instrumentation of unstable thoracolumbar burst fractures.
abstract: BACKGROUND
  Internal fixation of unstable thoracolumbar spine fractures requires correction of the lacking anterior column support. This usually entails insertion of a vertebral body replacement strut through an anterior approach, or a long posterior construct spanning at least two vertebrae above and two vertebrae below the fracture. Posterior short-segment pedicle instrumentation (SSPI)--one vertebra above and below--is suitable for approximately 40% of fractures, but not for all.
  
  
  METHODS
  A total of 52 patients with unstable thoracolumbar burst fractures meeting our inclusion criteria were instrumented using a novel approach, combining percutaneous SSPI, pedicle screw augmentation with polymethyl methacrylate (PMMA) and fractured vertebra kyphoplasty. We retrospectively reviewed patient and fracture data, operative results and 1 year radiographic follow-up postoperatively in 40 of the patients. We reviewed operative complications of all 52 patients.
  
  
  RESULTS
  Most fractures were AO/Magerl type A3.1, A3.2 and A3.3. They were instrumented within 72 h and ambulated without additional external bracing. Operative time averaged 2 h and blood loss was less than 50 cc in most cases. Complications were mostly related to PMMA leakage. On average, 3.3° (0-13) of correction was lost after 3 months, but remained constant afterward.
  
  
  CONCLUSIONS
  Percutaneous augmented short-segment pedicle instrumentation of unstable thoracolumbar fractures can be done with short operative times, minimal blood loss and a low complication rate. The radiographical results at 1 year are equal to anterior stabilization and are better than other posterior-only techniques.
authors.affiliation: Spine Surgery Unit, Western Galilee Hospital, P.O. Box 21, Naharia, Israel. nim205@gmail.com
authors.forename: Nimrod
authors.initials: N
authors.lastname: Rahamimov
authors.forename: Hani
authors.initials: H
authors.lastname: Mulla
authors.forename: Adi
authors.initials: A
authors.lastname: Shani
authors.forename: Shay
authors.initials: S
authors.lastname: Freiman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D006801:Humans; D016268:Internal Fixators; D058498:Kyphoplasty / Q000295:instrumentation / Q000379:methods*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D019904:Polymethyl Methacrylate; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019904:Polymethyl Methacrylate