title: Combined open decompressive laminectomy and vertebroplasty for treatment of thoracolumbar fractures retrospective review of 41 cases.
abstract: BACKGROUND
  Vertebral compression fractures are common, and can occur concomitantly in patients with symptomatic degenerative stenosis. Less commonly, complicated vertebral body fractures may involve retropulsion of bone into the spinal canal, resulting in stenosis with myelopathy and/or radiculopathy. Decompression of the neural elements can lead to destabilization and progressive kyphotic deformity. Laminectomy combined with open vertebroplasty provides a way to decompress the neural elements and stabilize the anterior columns in patients who cannot tolerate extended surgical time or complications associated with instrumentation and fusion. The authors describe the combination of decompressive laminectomy and open transpedicular vertebroplasty as a means to decompress neural elements and simultaneously stabilize the anterior vertebral column.
  
  
  METHODS
  Forty-one patients with a total of 51 thoracolumbar fractures were included in this retrospective case review. A decompressive laminectomy was performed first, followed by vertebroplasty using an open transpedicular approach. For subjective assessment of outcome, the patients were assessed using the Oswestry Low Back Disability Questionnaire and additional questions pertaining to the patient's condition.
  
  
  RESULTS
  Out of 51 fractures, there were 15 burst fractures and 36 compression fractures. Fracture levels ranged from T12 to S1. The average follow-up period was 27 months (range, 0.5-60 months). The mean post-operative Oswestry score was 16 (range, 0-39), and all patients except for one were subjectively pleased with the results of the procedure and said they would recommend it to others. All patients were able to return to all routine activities of daily living.
  
  
  CONCLUSIONS
  The authors' cases indicate combining open decompressive laminectomies with vertebroplasty can be an effective treatment for patients with complicated thoracic and lumbar fractures without involving bone fusion or spinal instrumentation and with good long-term outcomes.
authors.affiliation: University of Nebraska Medical Center, Omaha, NE 68198-2035, USA. smboswel@unmc.edu
authors.forename: Scott
authors.initials: S
authors.lastname: Boswell
authors.forename: Michael
authors.initials: M
authors.lastname: Sather
authors.forename: Meysam
authors.initials: M
authors.lastname: Kebriaei
authors.forename: Katie
authors.initials: K
authors.lastname: Lydiatt
authors.forename: Brad
authors.initials: B
authors.lastname: Bowdino
authors.forename: Daniel
authors.initials: D
authors.lastname: Tomes
authors.forename: John
authors.initials: J
authors.lastname: Treves
authors.forename: Les
authors.initials: L
authors.lastname: Hellbusch
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D017116:Low Back Pain / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery*; D008175:Lung Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications; D010147:Pain Measurement / Q000379:methods; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D054854:Vertebroplasty / Q000379:methods*