Transpedicular short-segment stabilization of thoracic and lumbar spine fractures with transepiphyseal reposition and vertebloplasty using lyophilized bone or bone substitute. Preliminary report

Author(s): ROMAN NOWAK, ANDRZEJ BARCZYŃSKI, WITOLD MIECZNIKOWSKI, JACEK SZPUNAR

Introduction: Short-segment stabilization with transepiphyseal screws is wide spread method of surgical care of thoracic and lumbar spine fractures. Satisfactory reposition of fractured vertebra can be obtained due to moments of forces transferred through screws on vertebral bodies. Such obtained reduction of fracture and its stabilization does not stand the test of time because of bone loss inside vertebral body and it can lead to instrumentarium destabilization and loss of correction. To avoid that problem in case of significant destruction of anterior column it is proposed to care the fractured vertebra from frontal access in isolated form or as addition to posterior stabilization. However, it is connected with elongation of operation time and much higher load for a patient, what is quite important in case of multi-organ injuries. Minimally invasive operations of kyphoplasty and lordoplasty using bone cement with transepiphyseally introduced system (balloon, expander) into vertebral body causing reconstruction of anatomical shape of the vertebra is recently more and more popular in treatment of pathological spinal fractures. However, application of bone cement in the treatment of traumatic spine fractures especially in young persons seems to be controversial. The aim: The aim of the paper was to present treatment results and own experiences connected with surgical treatment of traumatic thoracic and lumbar spine fractures with transpedicular short-segment stabilization connected with transepiphyseal reposition of the fracture and filling the losses in vertebral body with allogenic grafts or bone substitute in group of 19 patients. Evolution of the surgical technique from transepiphyseal reposition with use of bend probe to application of a system of mechanical expander Xvoid was presented. Material and methods: Results obtained till now allow to form following statements: 1) Fractures reposition of lamina of the vertebral bodies is possible on the basis of transepiphyseal access to the vertebra, 2) Transepiphyseal vertebroplasty with use of allogenic grafts or bone substitute allows for greatly reconstruction of mechanical competence of injured anterior spinal column, 3) Embrace instrumentation with screws of fractured vertebral pedicle additionally fills losses of bone in vertebra and increases stability of the connection. Conclusions: 1) Fractures reposition of lamina of the vertebral bodies is possible on the basis of transepiphyseal access to the vertebra, 2) Transepiphyseal vertebroplasty with use of allogenic grafts or bone substitute allows for greatly reconstruction of mechanical competence of injured anterior spinal column, 3) Embrace instrumentation with screws of fractured vertebral pedicle additionally fills losses of bone in vertebra and increases stability of the connection.