title: Subpedicle decompression and vertebral reconstruction for thoracolumbar Magerl incomplete burst fractures via a minimally invasive method.
abstract: METHODS
  Retrospective.
  
  
  OBJECTIVE
  To evaluate the clinical and radiographical results.
  
  
  BACKGROUND
  The evolution of posterior approach for burst fractures was from long-segment to short-segment and then to monosegmental fixation. Decompression of the spinal cord is performed by anterior or posterior approaches. The technique attempts to decompress the spinal cord by a paramedian subpedicle approach, and simultaneous vertebral reconstruction with pile-up titanium spacers (subpedicle decompression and body augmentation [SpBA]) was developed.
  
  
  METHODS
  Eighty patients with symptomatic single thoracolumbar Magerl incomplete burst fractures were included. After manual reduction, transpedicle body augmentation and shortsegment fixation (TpBA group) were performed in 38 patients and SpBA in 42 cases. The mean follow-up was 52.6 ± 18.7 (TpBA) and 42.1 ± 7.8 (SpBA) months, and the age was 57.9 ± 7.2 and 59.1 ± 8.3 years. Clinical and radiographical outcomes were analyzed.
  
  
  RESULTS
  The operation time was 66 ± 11 (TpBA) versus 34.5 ± 5.5 (SpBA) minutes. The initial anterior vertebral correction was 46.8 ± 12.2% (TpBA) versus 53.2 ± 15.0% (SpBA) (P = 0.03) and the final correction was 44.0 ± 10.8% versus 51.5 ± 15.3% (P = 0.01). Initial corrections of the lateral Cobb angle were 22.3° ± 2.6° versus 22.8° ± 2.7° and the final corrections were 19.1° ± 3.4° versus 20.5° ± 2.9°. The VAS score was 7.7 ± 1.2 versus 7.9 ± 1.2 preoperatively and 2.2 ± 0.7 versus 1.8 ± 0.6 (P = 0.02) at the final visit. Seventy-five patients maintained or recovered to Frankel grade E. Three patients in the TpBA group and 2 in the SpBA group improved from grade C to D. Technical complications included 1 root overstretch in the SpBA group and one incomplete decompression in the TpBA group.
  
  
  CONCLUSIONS
  SpBA is a safe and fast technique to treat Magerl incomplete burst fractures and leads to good clinical results.
  
  
  METHODS
  N/A.
authors.affiliation: *Department of Orthopaedic Surgery, Chiayi Yang-Ming Hospital, Chiayi, Taiwan, ROC †Institute and Faculty of Physical Therapy, National Yang-Ming University, Taipei, Taiwan, ROC ‡Department of Orthopaedic Surgery, E-Da Hospital, Kaohsiung City, Taiwan, ROC §School of Medicine, University of Pittsburgh, Pittsburgh, PA; and ¶Department of Neurosurgery, Chiayi Yang-Ming Hospital, Chiayi, Taiwan, ROC.
authors.forename: Kung-Chia
authors.initials: KC
authors.lastname: Li
authors.forename: Shang-Won
authors.initials: SW
authors.lastname: Yu
authors.forename: Allen
authors.initials: A
authors.lastname: Li
authors.forename: Ching-Hsiang
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Ting-Hua
authors.initials: TH
authors.lastname: Liao
authors.forename: Ju-Hung
authors.initials: JH
authors.lastname: Chen
authors.forename: Shu-Jung
authors.initials: SJ
authors.lastname: Wu
authors.forename: Chih-Shen
authors.initials: CS
authors.lastname: Lu
mesh_terms: D000368:Aged; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D014025:Titanium