title: Less invasive reduction and fusion of fresh A2 and A 3 traumatic L 1-L 4 fractures with a novel vertebral body augmentation implant and short pedicle screw fixation and fusion.
abstract: The aim of this clinical study was to report on the efficacy in reduction and safety in PMMA leakage of a novel vertebral augmentation technique with PEEK and PMMA, together with pedicle screws in the treatment of fresh vertebral fractures in young adults. Twenty consecutive young adults aged 45 ± 11 years with fresh burst A3/AO or severely compressed A2/AO fractures underwent via a less invasive posterior approach one-staged reduction with a novel augmentation implant and PMMA plus 3-vertebrae pedicle screw fixation and fusion. Radiologic parameters as segmental kyphosis (SKA), anterior (AVBHr) and posterior vertebral body height ratio (PVBHr), spinal canal encroachment (SCE), cement leakage and functional parameters as VAS, SF-36 were measured pre- and post-operatively. Hybrid construct restored AVBHr (P < 0.000), PVBHr (P = 0.02), SKA (P = 0.015), SCE (P = 0.002) without loss of correction at an average follow-up of 17 months. PMMA leakage occurred in 3 patients (3 vertebrae) either anteriorly to the fractured vertebral body or to the adjacent disc, but in no case to the spinal canal. Two pedicle screws were malpositioned (one medially, one laterally to the pedicle at the fracture level) without neurologic sequelae. Solid posterolateral spinal fusion occurred 8-10 months post-operatively. Pre-operative VAS and SF-36 scores improved post-operatively significantly. This study showed that this novel vertebral augmentation technique using PEEK implant and PMMA reduces and stabilizes via less invasive technique A2 and A3 vertebral fractures without loss of correction and leakage to the spinal canal.
authors.affiliation: Orthopaedic Department, General Hospital "Agios Andreas" Patras, Charalambi Str. 65-67, Patras, Greece, korovess@otenet.gr.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Korovessis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vardakastanis
authors.forename: Thomas
authors.initials: T
authors.lastname: Repantis
authors.forename: Vasilios
authors.initials: V
authors.lastname: Vitsas
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D001843:Bone Cements / Q000627:therapeutic use; D001863:Bone Screws; D005260:Female; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery*; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D007902:Length of Stay; D017116:Low Back Pain / Q000601:surgery; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D061646:Operative Time; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D011859:Radiography; D016103:Spinal Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate