title: Safe surgical technique: cement-augmented pedicle screw instrumentation and balloon-guided kyphoplasty for a lumbar burst fracture in a 97-year-old patient.
abstract: BACKGROUND
  During the last few years, an increasing number of unstable thoracolumbar fractures, especially in elderly patients, has been treated by dorsal instrumentation combined with a balloon kyphoplasty. This combination provides additional stabilization to the anterior spinal column without any need for a second ventral approach.
  
  
  METHODS
  We report the case of a 97-year-old male patient with a lumbar burst fracture (type A3-1.1 according to the AO Classification) who presented prolonged neurological deficits of the lower limbs - grade C according to the modified Frankel/ASIA score. After a posterior realignment of the fractured vertebra with an internal screw fixation and after an augmentation with non-absorbable cement in combination with a balloon kyphoplasty, the patient regained his mobility without any neurological restrictions.
  
  
  CONCLUSIONS
  Especially in older patients, the presented technique of PMMA-augmented pedicle screw instrumentation combined with balloon-assisted kyphoplasty could be an option to address unstable vertebral fractures in "a minor-invasive way". The standard procedure of a two-step dorsoventral approach could be reduced to a one-step procedure.
authors.affiliation: Department of Traumatology, Eberhard Karls Universität Tübingen, Schnarrenbergstrasse 95, Tübingen, 72076, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Freude
authors.affiliation: Department of Traumatology, Eberhard Karls Universität Tübingen, Schnarrenbergstrasse 95, Tübingen, 72076, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: König
authors.affiliation: Department of Traumatology, Klinikum Rechts der Isar, Technische Universität Muenchen, Ismaninger Strae 22, Munich, 80809, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Martetschläger
authors.affiliation: Department of Traumatology, Klinikum Rechts der Isar, Technische Universität Muenchen, Ismaninger Strae 22, Munich, 80809, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Siebenlist
authors.affiliation: Department of Traumatology, Klinikum Rechts der Isar, Technische Universität Muenchen, Ismaninger Strae 22, Munich, 80809, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Neumaier
authors.affiliation: Department of Traumatology, Eberhard Karls Universität Tübingen, Schnarrenbergstrasse 95, Tübingen, 72076, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stöckle
authors.affiliation: Department of Traumatology, Eberhard Karls Universität Tübingen, Schnarrenbergstrasse 95, Tübingen, 72076, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Döbele