The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation: a prospective study.

Study Design. Prospective consecutive series. Objective. To evaluate the outcomes of the treatment of acute thoracolumbar burst fractures by transpedicular hydroxyapatite grafting following indirect reduction and pedicle screw fixation. Summary of Background Data. In the treatment of thoracolumbar burst fractures, the major problem after posterior correction and instrumentation is failure to support the anterior spinal column, leading to the loss of correction of kyphosis and instrumentation breakage. Methods. There were 15 consecutive patients who had thoracolumbar burst fractures and associated incomplete neurologic deficit. They underwent surgery within 4 days of admission, had their implants removed within 1 year, and were prospectively followed for at least 2 years. Following indirect reduction and pedicle screw fixation, transpedicular intracorporeal hydroxyapatite grafting to the fractured vertebrae was performed. Median operating time was 130 minutes, and median blood loss was 155 g. Results. The neurologic function of all 15 patients improved by at least 1 American Spine Injury Association grade, with 9 (60%) having complete neurologic recovery. Sagittal alignment was improved from a median preoperative kyphosis of 20 to -1 degrees (lordosis) by surgery but was found to have slightly deteriorated to 1 at final follow-up observation. Computerized tomography showed a median spinal canal narrowing of 64%, 22%, and 11%, respectively. There were no instances of instrumentation failure. Conclusions. Posterior indirect reduction, transpedicular hydroxyapatite grafting, and pedicle screw fixation could provide reliable neurologic improvement in patients with incomplete neurologic deficit, and could prevent the development of kyphosis. This technique does not require fusion to a segment, thereby preserves thoracolumbar motion.