Anatomical reconstruction of complete burst vertebral fracture case report-combined reduction methods and armed kyphoplasty with stents filled with bone graft.

Abstract

Background: Minimally invasive techniques used to augment the fractured vertebral body have acquired popularity thanks to their capacity to stabilize the anterior spine via the percutaneous posterior pathway.

Case description: We present a clinical case of a 50-year-old male patient with a traumatic complete burst fracture of L1 vertebral body treated by L1 laminectomy, percutaneous pedicle instrumentation D11-D12-L2-L3 and indirect fracture reduction, followed by direct reduction by armed kyphoplasty with stents filled with bone graft. We describe the details of the surgical technique, as well as clinical and imaging outcomes. After 3-year follow-up, the patient is practically asymptomatic and control computed tomography demonstrates vertebral body fracture healing and maintenance of the vertebral heights recorded in the immediate postoperative period, without signs of loosening, migration or failure of intrasomatic stents or pedicle screws, as well as of bone graft resorption, which indicates its osseointegration and healing. We discuss the concepts of indirect and direct reduction and the rationale for anatomical vertebral restoration and for the use of intrasomatic bone graft.

Conclusions: We present a detailed description of a promising surgical technique combining indirect and direct reduction and vertebral body interior replacement with stents filled with bone graft, as a treatment that allows for a complete burst fracture to be anatomically restored by a posterior and minimally invasive approach. Also, we demonstrate a fast and full recovery, avoiding the morbidity and risk of serious complications of anterior approaches. Nevertheless, long-term prospective studies are necessary so as to prove the effectiveness and assets of this surgical option versus other common techniques in complete burst fractures.