- 2021;24;E631-E638Treatment of Thoracolumbar Type A3 Fractures Using a Percutaneous Intravertebral Expandable Titanium Implant: Long-term Follow-up Results of a Pilot Single Center Study
David C. Noriega, PhD, Jesus Crespo-Sanjuan, PhD, Wayne J. Olan, MD, Ruben Hernandez-Ramajo, PhD, Douglas P. Bell, PhD, J. Javier Castrodeza Sanz, PhD, Gregorio de Jesus Labrador Hernandez, MD, Israel Sanchez-Lite, PhD, and Francisco Ardura, PhD.
BACKGROUND: There are controversies about the optimal management of AO subtype A3 burst fractures. The most common surgical treatment consists of posterior fixation with pedicle screw and rod augmentation. Nevertheless, a loss of correction in height restoration and kyphotic reduction has been observed.
OBJECTIVES: The aim of this study was to assess long-term outcomes of a minimally invasive technique using a percutaneous intravertebral expandable titanium implant (PIETI).
STUDY DESIGN: This prospective, single center, pilot study was carried out on a consecutive case series of 44 patients with acute (< 2 weeks) traumatic thoracolumbar fractures AO type A3. The average follow-up was 5.6 years.
SETTING: A single center in Castilla y Leon, Spain
METHODS: Clinical outcomes (pain intensity on visual analog scale [VAS], Oswestry Disability Index [ODI], analgesic consumption) and radiographic outcomes (anterior/mid/posterior vertebral body height, vertebral area, local kyphosis angle, traumatic regional angulation) were analyzed before surgery, at one month after surgery, and at the end of the follow-up period.
RESULTS: At one-month postsurgery, significant improvements in VAS score and ODI score were observed. PIETI achieved significant vertebral body height restoration with median height increases of 2.9 mm/4.3 mm/2.3 mm for anterior/middle/posterior parts, respectively. Significant correction of the local kyphotic angle and improvement of the traumatic regional angulation were accomplished. All these improvements were maintained throughout the follow-up period. The only complication reported was a case of cement leakage.
LIMITATIONS: In our opinion, the main limitation of the study is the small number of patients. However, the sample is superior to that shown in other papers.
CONCLUSIONS: This study showed that using a PIETI in the treatment of fractures type A3 is a safe and effective method that allows marked clinical improvement, as well as anatomical vertebral body restoration. Unlike with other treatments, results were maintained over time, allowing a better long-term clinical and functional improvement. The rate of cement leakage was lower than other reports.
KEY WORDS: Traumatic thoracolumbar fractures, burst fractures, AO type A3 fractures, kyphoplasty, percutaneous intravertebral expandable titanium implant