Additional vertebral augmentation with posterior instrumentation for unstable thoracolumbar burst fractures

Background To investigate the role of vertebral augmentation in kyphosis reduction, vertebral fracture union, and correction loss after surgical management of thoracolumbar burst fracture. Design Retrospective chart and radiographic review. Setting Level 1 trauma center. Methods The analysis included patients treated between April 2007 and June 2015, who received pedicle-screw-rod distraction and reduction within two days following acute traumatic thoracolumbar burst fracture with a load sharing score >6. Medical records were retrospectively reviewed for data regarding operative details, imaging and laboratory findings, neurological function, and functional outcomes. Intervention Not applicable. Main outcome measures Sagittal index, pain score, loss of correction, and implant failure rate. Results Nineteen patients were enrolled in this study (mean age, 37.2 ± 13 years; age range, 17–62 years; female/male ratio: 10/9). Of the five patients who received only reduction (no augmentation), one underwent revision surgery because of implant failure and pedicle screw backing out. Compared to patients who received only reduction, those who received both reduction and augmentation showed better sagittal alignment after the operation, with better sagittal index immediately postoperatively and during the follow-up (p < 0.05). Conclusions Transpedicular vertebral augmentation with calcium sulfate/phosphate-based bone cement may reinforce thoracolumbar burst fracture stability, partially restore vertebral body height, and reduce pedicle screw bending and movement, thereby preventing early implant failure and late loss of correction, especially in patients with excellent fracture reduction.