Transpedicular Corpectomy and Cage Placement in the Treatment of Traumatic Lumbar Burst Fractures

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Study Design:Retrospective review.Objective:To review the feasibility of a posterior-only approach for instrumented reconstruction in lumbar burst fractures.Background:Burst fractures of the lumbar spine have been treated through a variety of techniques, including anterior, posterior, or combined approaches. Here we review series of patients undergoing posterior-only transpedicular corpectomy with instrumented fusion for traumatic lumbar burst fracture.Methods:All patients treated at the Los Angeles County+University of Southern California (LAC+USC) Medical Center who had sustained traumatic lumbar burst fractures from February 2005 to February 2014 were reviewed.Results:A total of 178 traumatic lumbar burst fractures were identified of which 89 required operative intervention. Of those 89 operations, 7 patients underwent posterior-only approach for transpedicular corpectomy. Levels operated on were at L1 (4 patients), L2 (1 patient), and L4 (2 patients). The mean age was 35 years of age (range, 21–56 y), and mechanism of injury was either motor vehicle accident (5 patients) or fall (2 patients). Initial neurological examination was American Spinal Injury Association (ASIA) B in 3 patients, ASIA D in 3 patients, and 1 patient was neurologically intact. Mean thoracolumbar injury classification and severity score on presentation was 6.4 (range, 5–8), whereas the mean load sharing classification score was 7.4 (range, 7–9). Of patients who were not immediately lost to follow-up on hospital discharge, mean clinical follow-up was 45.3 months (range, 18.8–68.6 mo), whereas mean radiographic follow-up was 28.8 months (range, 1.3–63.6 mo). At the last known radiographic follow-up, no patient had gross hardware fracture, pseudoarthrosis, or adjacent segment disease. One patient with the longest radiographic follow-up of 63.6 months was noted to have some minimal subsidence of his cage with no other change in his other hardware.Conclusion:A posterior-only approach for transpedicular corpectomy and instrumented fusion is a viable treatment option for lumbar burst fracture which allows for reconstruction of the anterior column while avoiding many of the risks and complications associated with an anterior or combined approach.

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