Vertebral fractures heal after combined kyphoplasty, short segmental fixation

Surgeons decreased average segmental kyphosis 14° postoperatively with few overall complications.

Issue: Issue 4 2008

Greek surgeons quickly and effectively reduced vertebral burst or severe compression fractures at L1-L4 using a technique that combines balloon kyphoplasty, bone cement and short posterior segmental fusion performed with cannulated pedicle screws.

Panagiotis Korovessis, MD, PhD
Panagiotis Korovessis

Among the benefits of the procedure, which is recommended for use shortly after a trauma or fall, were restored vertebral body height at the fractured levels and an absence of neurologic complications related to bone cement leakage, according to investigators in a prospective study of 18 consecutive patients.

Panagiotis Korovessis, MD, PhD, reported on the technique which he used for 4 years during the recent Spine Week 2008 meeting. The study was also published in Spine earlier this year.

“In this series, kyphoplasty with calcium phosphate bone cement supplemented with minimally invasive short fixation and fusion provided excellent, immediate reduction and maintenance of post-traumatic segmental kyphosis and spinal column encroachment,” he said.

Short pedicle-screw fixation

Patients in the investigation averaged 64 years-old and had severe burst or compression vertebral fractures treated within 24 hours of hospital admission. Two patients presented with incomplete neurologic impairment.

In each case surgeons performed a bilateral balloon kyphoplasty procedure using calcium phosphate bone cement to reduce kyphosis angles that were 16° preoperatively. They augmented the kyphoplasty by using cannulated instrumentation to introduce a short segment pedicle screw to fuse fragments of the fractured vertebra.

“Intraoperative myography showed that the spinal column clears during kyphoplasty,” Korovessis noted.

Patients achieved posterolateral fusion on radiograph and CT by about 6 to 8 weeks postop with Christiansen fusion scores that ranged from 2 to 3 points.

Image: Korovessis P

VAS improved

Investigators assessed outcomes at 22 months average (17 to 28 months). They evaluated patients based on improvements in anterior and posterior vertebral height ratio, Gardner kyphosis angle, spinal canal encroachment, Visual Analog Scale (VAS) and the role physical and bodily pain domains of the SF-36 instrument.

“Regarding functional results, at the longest follow-up VAS was significantly improved, as well as role physical and bodily pain. One patient who had an incomplete neurological condition recovered within 6 months after surgery,” Korovessis said.

The segmental kyphosis angle improved significantly with an average postoperative angle of 2°, representing a 14° improvement from preoperative measurements (P<.0001).

Reduced encroachment

Spine Week

Korovessis and colleagues graded the fusions as 2.6, average, using Christiansen’s scoring system.

Anterior vertebral height increased significantly from 0.57 cm preoperatively to 0.87 cm postoperatively. Lesser improvements in posterior vertebral height were seen but were not significant.

The 25% preoperative rate of spinal canal encroachment reduced to 19% after surgery (P <.07).

“Bone cement leakage was observed anterior to the fractured vertebral body or in the adjacent superior disc in 4 patients, however without any sequelae. We saw no calcium bone cement cracks,” Korovessis said.

During the discussion period Robert C. Mulholland, FRCS, Nottingham, England, said he was impressed with the results since other investigators have found effectively fixing vertebral fractures challenging because of how difficult it is to capture the fragments.

“You have a much sounder construct and I congratulate you. You seemed to achieve it every time,” he said.

For more information:

Panagiotis Korovessis, MD, PhD, is chief of the Orthopaedic Department at General Hospital of Patras “Agios Andreas.” He can be reached at 1 Tsertidou St., Patras, 26224 Greece; +30-610-315-824; e-mail: korovess@otenet.gr. He has no direct financial interest in any products or companies mentioned in this article.

Robert C. Mulholland, FRCS, can be reached at 34 Regent St., Nottingham NG1 5BT, England; +44-115-9561303; e-mail: mulhollandrcm@aol.com.

References:

Korovessis P, Repantis T, Hadjipavlou A. Minimal invasive short posterior instrumentation plus balloon kyphoplasty with calcium phosphate for fresh burst and severe compression lumbar fractures. Spine. 2008;33(6):658-667.

Korovessis P, Repantis T, Petsinis G. Kyphoplasty with calcium phosphate and short minimal invasive fixation for fresh burst and severe compression lumbar fractures. Paper AB32. Presented at Spine Week 2008. May 26-31, 2008. Geneva.