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Journal of Neurosurgical Sciences 2019 Apr 23

DOI: 10.23736/S0390-5616.19.04628-9


language: English

Reconstruction of vertebral body in thoracolumbar AO type A post-traumatic fractures by balloon kyphoplasty. A series of 85 patients with a long follow-up and review of literature

Natale FRANCAVIGLIA 1, Alessandro VILLA 1 , Marco MAIELLO 2, Gabriele COSTANTINO 1, Raffaele F. ALESSANDRELLO 3, Francesco MELI 1, Antonino ODIERNA CONTINO 1, Rita LIPANI 3, Vito FIORENZA 1, Benedetto LO DUCA 1, Francesco ASCANIO 1, Domenico G. IACOPINO 4, Rosario MAUGERI 4

1 Division of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy; 2 Neurosurgical Unit, “Elio Tartarini” Centre of Neurosciences, Santa Corona Hospital, Pietra Ligure, Savona, Italy; 3 Division of Neurosurgery, Sant’Elia General Hospital, Caltanissetta, Italy; 4 Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, School of Medicine, University of Palermo, Palermo, Italy


BACKGROUND: Traumatic fractures of the thoracolumbar spine are common injuries, accounting for approximately 90% of all spinal traumas. Optimal management of these fractures still gives rises to much debate in the literature. Currently, one of the treatment options in young patients with stable traumatic vertebral fractures is conservative treatment using braces. Kyphoplasty as a minimally invasive procedure has been shown to be effective in stabilizing vertebral body fractures, resulting in immediate pain relief and improved physical function with early return to work activity. The aim of the study is to report VAS, ODI scores, and kyphosis correction following treatment.
METHODS: This is a retrospective study to investigate the clinical and radiological results 10 years after percutaneous balloon kyphoplasty followed by cement augmentation with polymethylmethacrylate (PMMA) or calcium phosphate cements (CPC), according to age, in 85 consecutive patients affected by 91 AOSpine type A traumatic fractures of the thoracolumbar spine (A1, A2, and A3). Clinical follow-up was performed with the Visual Analogic Scale (VAS) at the preoperative visit and in the postoperative follow-up after 1 week, 1, 6, 12 months, and each year up to 10 years. Additionally, the Oswestry Disability Index (ODI) improvement was calculated as the difference between the ODI scores at the preoperative visit and at final follow-up. Finally, the Cobb angle from this cohort was assessed before surgery, immediately postoperatively, and at the end of follow-up.
RESULTS: Kyphoplasty markedly improved pain and resulted in statistically significant vertebral height restoration and normalization of morphologic shape indexes that remained stable for at least 10 years following treatment.
CONCLUSIONS: The present study showed that kyphoplasty and cement augmentation are an effective method of treatment for selected type A fractures.

KEY WORDS: Balloon kyphoplasty - AOSpine classification - Type A fractures - Spinal trauma - Pain - Polymethylmethacrylate bone cement - Calcium phosphate cement

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