DOI: 10.1097/BRS.0b013e3181bb1577
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Issn Print: 0362-2436
Publication Date: 2009/10/15
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Excerpt
Re: Korovessis P, Hadjipavlou A, Repantis T. Minimal invasive short posterior instrumentation plus balloon kyphoplasty with calcium phosphate for burst and severe compression lumbar fractures. Spine 2008;33:658–67.
We read this study with interest. We cannot argue against the benefits of minimally invasive surgery, but this does not necessarily mean that it is a priori superior compared to alternatives. In this context, 2 questions need to be answered:
We think this study fails to provide satisfactory answers to both. All patients have AO type A2 or A3 axial loading injuries, previously reported to be far less amenable to loss of correction compared to rotational injuries.1,2 A recent review failed to show any differences in pain, function-related outcomes, rates of return to work, and radiographic findings in compression injuries treated surgically or nonsurgically.3 Therefore, surgery was probably unnecessary for the patients in this study.
As for efficacy, this study presents short-term results of a new and expensive version of short instrumentation and transpedicular grafting. Short instrumentation has been shown to be plagued with a high rate of loss of correction.4 Transpedicular grafting was offered as a solution, but studies failed to show any advantages.2,4,5 Therefore, the presented approach may be a simple repetition of previously failed surgery, but is not even comparable to previous studies because of the lack of a reasonable length of follow-up.
In addition, there are concerns regarding safety. The rates of complications are higher with surgery. This study reports a high rate of (4/18) cement leakage that can potentially be a very morbid complication of kyphoplasty.6 As the long-term complication rate remains to be unknown, it is easy to think that this approach may combine the complications of kyphoplasty with those of instrumented fusions.
As a conclusion, we think that this study must be reevaluated in terms of the necessity, efficacy, and safety of surgery. A “minimally invasive” surgery performed unnecessarily and without any clear-cut advantages becomes “very invasive.
