Use of the SpineJack direct reduction for treating type A2, A3 and A4 fractures of the thoracolumbar spine: a retrospective case series

J Neurointerv Surg. 2022 Sep;14(9):931-937. doi: 10.1136/neurintsurg-2021-017682. Epub 2021 Aug 25.

Abstract

Background: Compression injuries of the thoracolumbar spine without neurological impairment are usually treated with minimally invasive procedures. Intravertebral expandable implants represent an alternative strategy in fractures with low fragments' displacement.

Methods: Patients with A2, A3 and A4 fractures of the T10-L2 spinal segment without neurological impairment, fracture gap >2 mm, vertebra plana, pedicle rupture, pedicle diameter <6 mm, spinal canal encroachment ≥50%, and vertebral body spread >30% were treated with the SpineJack device. Patients with pathological/osteoporotic fractures were excluded. Demographic and fracture-related data were assessed together with vertebral kyphosis correction, vertebral height restoration/loss of correction and final kyphosis. The modified Rankin Scale (mRS), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), Smiley-Webster Pain Scale (SWPS) and EuroQol-5D (EQ-5D) were evaluated at 1 (-post), 6 and 12 months (-fup) after surgery. Statistical analysis was performed and p values ≤0.05 were considered significant.

Results: Fifty-seven patients were included in the study. Patients aged >60 years reported worse kyphosis correction (<4°) with more postoperative complications, while vertebral plasticity in younger patients, fragmentation-related greater remodeling in A3/A4 fractures, and treatments within 7 days of trauma determined superior wedging corrections, with better EQ-5D-post and mRS-fup. Cement leakages did not affect functional outcome, while female gender and American Society of Anesthesiologists (ASA) score of 3-4 were associated with worse ODI-fup and VAS-fup. Although fracture characteristics and radiological outcome did not negatively influence the clinical outcome, A2 fracture was a risk factor for complications, thus indirectly compromising both the functional and radiological outcome.

Conclusion: With spread of <30%, the SpineJack is an alternative to minimally invasive fixations for treating A3/A4 thoracolumbar fractures, being able to preserve healthy motion segments in younger patients and provide an ultra-conservative procedure for elderly and fragile patients.

Keywords: lumbosacral; spine; technique; thoracic; trauma.

MeSH terms

  • Aged
  • Female
  • Fractures, Compression* / diagnostic imaging
  • Fractures, Compression* / surgery
  • Humans
  • Kyphosis* / complications
  • Kyphosis* / diagnostic imaging
  • Kyphosis* / surgery
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / injuries
  • Lumbar Vertebrae / surgery
  • Osteoporotic Fractures* / surgery
  • Retrospective Studies
  • Spinal Fractures* / complications
  • Spinal Fractures* / diagnostic imaging
  • Spinal Fractures* / surgery
  • Thoracic Vertebrae / diagnostic imaging
  • Thoracic Vertebrae / injuries
  • Thoracic Vertebrae / surgery
  • Treatment Outcome