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An Unconventional Treatment: Kyphoplasty as an Indirect Decompression Technique for Posterior Wall Retropulsion of Fractured Vertebral Body

Year 2024, Volume: 4 Issue: 2, 32 - 38, 31.08.2024

Abstract

There is no clear consensus on how to manage burst fractures that involve retropulsion of bony fragments of the posterior wall of the vertebral body. Many surgeons consider kyphoplasty relatively contraindicated due to technical challenges, increased risk of epidural cement leakage, and potential for further displacement of fragments into the central canal, which could potentially worsen the neurologic condition. We present the case of a neurologically intact 45-year-old man with a burst fracture at the T8 level and ≈50% compromised spinal canal with RWR. Kyphoplasty was performed. There was no cement leakage during the procedure. Pain relief is achieved immediately after surgery (VAS decreased from 7 to 2), and no neurological deterioration occurred. He could go back to work without pain within one week. Significant postoperative correction of kyphosis (wedge angle decreased from 22.6 to 6.9) and restoration of vertebral height (Beck index increased from 37.84% to 72.62%) was observed and was not lost during follow-up for a year (wedge angle 9.4, Beck index 75.81%). Retropulsion decreased from 7.8 mm (46,43% canal compromise) to 5.57 mm (33.15% canal compromise). At 1-year follow-up, the posterior wall appeared intact and there was almost no retropulsed fragment. Kyphoplasty for burst fractures with PWR can be an effective option for selected patients.

Ethical Statement

Publication Ethics Declaration Form (In English) As the authors of the article, we declare in this form that scientific and ethical rules are followed in this article and that the article does not require the permission of ethical committee for the following reasons: • During the writing process of our study, the information of which is given above, international scientific, ethical and citation rules have been followed, no falsification has been made on the data collected. • In the article, a case report that have already received normal medical treatment are presented retrospectively. Permission was obtained from the clinic administrator for this article. • Consent was obtained from the patient that his medical information and images could be included in medical books, published in a journal or on the website. • The identity of the patient or any information that would lead to their identity was not shared.

Supporting Institution

Not applicable

Thanks

-

References

  • Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983; 8(8):817-31. Doi: 10.1097/00007632-198311000-00003.
  • Rajasekaran S. Thoracolumbar burst fractures without neurological deficit: The role for conservative treatment. Eur Spine J 2010; 19(Suppl 1):40-7. Doi: 10.1007/s00586-009-1122-6.
  • Venier A., Roccatagliata L., Isalberti M., et al. Armed kyphoplasty: An indirect central canal decompression technique in burst fractures. AJNR Am J Neuroradiol 2019; 40(11):1965-72. Doi: 10.3174/ajnr.A6285.
  • Wang H., Zhang Z., Liu Y., Jiang W. Percutaneous kyphoplasty for the treatment of very severe osteoporotic vertebral compression fractures with spinal canal compromise. J Orthop Surg Res 2018; 13(1):13. Doi: 10.1186/s13018-018-0719-z.
  • Sadiqi S., Verlaan JJ., Lehr AM., et al. Measurement of kyphosis and vertebral body height loss in traumatic spine fractures: An international study. Eur Spine J 2017; 26(5):1483-91. Doi: 10.1007/s00586-016-4716-9.
  • Diel P., Röder C., Perler G., et al. Radiographic and safety details of vertebral body stenting: results from a multicenter chart review. BMC Musculoskelet Disord 2013; 14:233. Doi: 10.1186/1471-2474-14-233.
  • Krüger A., Zettl R., Ziring E., Mann D., Schnabel M., Ruchholtz S. Kyphoplasty for the treatment of incomplete osteoporotic burst fractures. Eur Spine J 2010; 19(6):893-900. Doi: 10.1007/s00586-010-1281-5.
  • Schwartz RH., Urits I., Shipon S., Viswanath O. Successful kyphoplasty in the presence of severe retropulsion of lumbar spine without neurological deficits. Pain Management Case Reports 2020; (4)4:127-29.
  • Teng MM., Wei CJ., Wei LC., et al. Kyphosis correction and height restoration effects of percutaneous vertebroplasty. AJNR Am J Neuroradiol 2003; 24(9):1893-900.,
  • Walter J., Haciyakupoglu E., Waschke A., Kalff R., Ewald C. Cement leakage as a possible complication of balloon kyphoplasty-- is there a difference between osteoporotic compression fractures (AO type A1) and incomplete burst fractures (AO type A3.1)? Acta Neurochir (Wien) 2012; 154(2):313-9. Doi: 10.1007/s00701-011- 1239-3.
  • Zhang J., Zhou Q., Zhang Z., Liu G. Comparison between unilateral and bilateral percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture: A meta‑analysis and systematic review. Exp Ther Med 2023; 26(6):553. Doi: 10.3892/etm.2023.12252..

Alışılmadık Bir Tedavi: Arka Duvar Retropülsiyonu Varlığında Dolaylı Dekompresyon Tekniği Olarak Kifoplasti

Year 2024, Volume: 4 Issue: 2, 32 - 38, 31.08.2024

Abstract

Vertebra gövdesinin arka duvarında kırık kemik parçaların retropulsiyonu (PWR) bulunan patlama kırıklarının yönetimi konusunda kesin bir fikir birliği sağlanamamıştır. Teknik zorluk, epidural sement sızıntısı riski ve kemik fragmanlarının santral kanalda daha fazla yer değiştirerek nörolojik durumun kötüleşmesine yol açabilme riski nedeniyle birçok cerrah kifoplastiyi nispeten kontrendike olarak değerlendirmektedir. Bu yazıda, T8 seviyesinde burst kırığı olan ve spinal kanalda ≈%50 oranında RWR ile basısı bulunan, nörolojik olarak sağlam 45 yaşında erkek hasta sunuldu. Kifoplasti uygulandı ve işlem sırasında çimento sızıntısı olmadı. Ameliyattan hemen sonra ağrı azalması sağlandı (VAS 7'den 2'ye düştü) ve nörolojik bozulma meydana gelmedi. Hasta bir hafta içinde ağrısız bir şekilde işine dönebildi. Ameliyat sonrası kifozda belirgin düzelme (kama açısı 22.,6'dan 6,9'a düşmüştür) ve vertebra yüksekliğinde restorasyon (Beck indeksi %37,84'ten %72,62'ye yükselmiştir) gözlenmiş ve bir yıllık takip sırasında kaybolmamıştır (kama açısı 9,4, Beck indeksi %75,81). Retropulsiyon 7.8 mm'den (%46,43 kanal basısı) 5.57 mm'ye (%33,15 kanal basısı) düştü. Bir yıllık takipte, arka duvar sağlam görünüyordu ve neredeyse hiç retropulse fragman yoktu. PWR'li patlama kırıkları için kifoplasti, seçilmiş hastalar için etkili bir seçenek olabilir.

Ethical Statement

Araştırma ve Yayın Etiği Beyan Formu (Türkçe) Makalenin yazarları olarak, bu makalede bilimsel ve etik kurallara uyulduğunu ve aşağıdaki nedenlerden dolayı makalenin etik kurul izni gerektirmediğini bu formda beyan ederiz: • Yukarıda bilgileri verilen çalışmamızın yazım sürecinde uluslararası bilimsel, etik ve atıf kurallarına uyulmuş, toplanan verilerde herhangi bir tahrifat yapılmamıştır. • Makalede daha önce normal tıbbi tedavi almış bir olgu, retrospektif olarak sunulmaktadır. Bu yazı için klinik yöneticisinden izin alınmıştır. • Hastadan tıbbi bilgi ve görsellerinin tıp kitaplarında yer alması, dergide veya internet sitesinde yayınlanması konusunda onam alınmıştır. • Hastanın kimliğini ortaya çıkaracak herhangi bir bilgi paylaşılmamıştır.

Supporting Institution

Bulunmamaktadır.

Thanks

-

References

  • Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983; 8(8):817-31. Doi: 10.1097/00007632-198311000-00003.
  • Rajasekaran S. Thoracolumbar burst fractures without neurological deficit: The role for conservative treatment. Eur Spine J 2010; 19(Suppl 1):40-7. Doi: 10.1007/s00586-009-1122-6.
  • Venier A., Roccatagliata L., Isalberti M., et al. Armed kyphoplasty: An indirect central canal decompression technique in burst fractures. AJNR Am J Neuroradiol 2019; 40(11):1965-72. Doi: 10.3174/ajnr.A6285.
  • Wang H., Zhang Z., Liu Y., Jiang W. Percutaneous kyphoplasty for the treatment of very severe osteoporotic vertebral compression fractures with spinal canal compromise. J Orthop Surg Res 2018; 13(1):13. Doi: 10.1186/s13018-018-0719-z.
  • Sadiqi S., Verlaan JJ., Lehr AM., et al. Measurement of kyphosis and vertebral body height loss in traumatic spine fractures: An international study. Eur Spine J 2017; 26(5):1483-91. Doi: 10.1007/s00586-016-4716-9.
  • Diel P., Röder C., Perler G., et al. Radiographic and safety details of vertebral body stenting: results from a multicenter chart review. BMC Musculoskelet Disord 2013; 14:233. Doi: 10.1186/1471-2474-14-233.
  • Krüger A., Zettl R., Ziring E., Mann D., Schnabel M., Ruchholtz S. Kyphoplasty for the treatment of incomplete osteoporotic burst fractures. Eur Spine J 2010; 19(6):893-900. Doi: 10.1007/s00586-010-1281-5.
  • Schwartz RH., Urits I., Shipon S., Viswanath O. Successful kyphoplasty in the presence of severe retropulsion of lumbar spine without neurological deficits. Pain Management Case Reports 2020; (4)4:127-29.
  • Teng MM., Wei CJ., Wei LC., et al. Kyphosis correction and height restoration effects of percutaneous vertebroplasty. AJNR Am J Neuroradiol 2003; 24(9):1893-900.,
  • Walter J., Haciyakupoglu E., Waschke A., Kalff R., Ewald C. Cement leakage as a possible complication of balloon kyphoplasty-- is there a difference between osteoporotic compression fractures (AO type A1) and incomplete burst fractures (AO type A3.1)? Acta Neurochir (Wien) 2012; 154(2):313-9. Doi: 10.1007/s00701-011- 1239-3.
  • Zhang J., Zhou Q., Zhang Z., Liu G. Comparison between unilateral and bilateral percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture: A meta‑analysis and systematic review. Exp Ther Med 2023; 26(6):553. Doi: 10.3892/etm.2023.12252..
There are 11 citations in total.

Details

Primary Language English
Subjects Brain and Nerve Surgery (Neurosurgery)
Journal Section Case Reports
Authors

Selin Bozdag 0000-0002-3355-8954

Ertan Sevin

Publication Date August 31, 2024
Submission Date May 21, 2024
Acceptance Date August 25, 2024
Published in Issue Year 2024 Volume: 4 Issue: 2

Cite

APA Bozdag, S., & Sevin, E. (2024). An Unconventional Treatment: Kyphoplasty as an Indirect Decompression Technique for Posterior Wall Retropulsion of Fractured Vertebral Body. Güncel Tıbbi Araştırmaları Dergisi, 4(2), 32-38. https://doi.org/10.52818/cjmr.1487864
AMA Bozdag S, Sevin E. An Unconventional Treatment: Kyphoplasty as an Indirect Decompression Technique for Posterior Wall Retropulsion of Fractured Vertebral Body. CJMR. August 2024;4(2):32-38. doi:10.52818/cjmr.1487864
Chicago Bozdag, Selin, and Ertan Sevin. “An Unconventional Treatment: Kyphoplasty As an Indirect Decompression Technique for Posterior Wall Retropulsion of Fractured Vertebral Body”. Güncel Tıbbi Araştırmaları Dergisi 4, no. 2 (August 2024): 32-38. https://doi.org/10.52818/cjmr.1487864.
EndNote Bozdag S, Sevin E (August 1, 2024) An Unconventional Treatment: Kyphoplasty as an Indirect Decompression Technique for Posterior Wall Retropulsion of Fractured Vertebral Body. Güncel Tıbbi Araştırmaları Dergisi 4 2 32–38.
IEEE S. Bozdag and E. Sevin, “An Unconventional Treatment: Kyphoplasty as an Indirect Decompression Technique for Posterior Wall Retropulsion of Fractured Vertebral Body”, CJMR, vol. 4, no. 2, pp. 32–38, 2024, doi: 10.52818/cjmr.1487864.
ISNAD Bozdag, Selin - Sevin, Ertan. “An Unconventional Treatment: Kyphoplasty As an Indirect Decompression Technique for Posterior Wall Retropulsion of Fractured Vertebral Body”. Güncel Tıbbi Araştırmaları Dergisi 4/2 (August 2024), 32-38. https://doi.org/10.52818/cjmr.1487864.
JAMA Bozdag S, Sevin E. An Unconventional Treatment: Kyphoplasty as an Indirect Decompression Technique for Posterior Wall Retropulsion of Fractured Vertebral Body. CJMR. 2024;4:32–38.
MLA Bozdag, Selin and Ertan Sevin. “An Unconventional Treatment: Kyphoplasty As an Indirect Decompression Technique for Posterior Wall Retropulsion of Fractured Vertebral Body”. Güncel Tıbbi Araştırmaları Dergisi, vol. 4, no. 2, 2024, pp. 32-38, doi:10.52818/cjmr.1487864.
Vancouver Bozdag S, Sevin E. An Unconventional Treatment: Kyphoplasty as an Indirect Decompression Technique for Posterior Wall Retropulsion of Fractured Vertebral Body. CJMR. 2024;4(2):32-8.