How I do it: spine jack expansion kyphoplasty for AO spine A4 complete burst fracture with neurological deficit

Background

Some patients suffering from thoracolumbar complete burst fracture causing neurological deficit may be eligible for single-stage posterior-only three column reconstruction with spine jack expansion kyphoplasty.

Method

Short segment monoaxial pedicle screws are placed. Spine jack working channels are positioned in the comminuted vertebral body. Then, the surgeon can perform jack expansion kyphoplasty and short-segment fixation and distraction in the order best suited, considering whether the collapsed vertebral body has been expanded thanks to hyperlordosis positioning. This strategy allows to regain both native vertebral body height and proper regional sagittal balance. Wide decompression with laminectomy and arthrectomy is necessary at the level of posterior wall recession.

Conclusion

Combination of short segment pedicle screw fixation with distraction and open spine jack kyphoplasty is technically feasible and avoids the need for corpectomy in complete burst fractures with neurological deficit.