Introduction: Burst fractures of the lumbar spine have been treated through a variety of techniques, including anterior, posterior, or combined approaches. We review here are series of patients undergoing posterior-only transpedicular corpectomy with instrumented fusion for traumatic lumbar burst fracture.
Methods: All patients treated at the LAC+USC Medical Center who had sustained traumatic lumbar burst fractures from February 2005 to February 2014 were reviewed.
Results: A total of 178 traumatic lumbar burst fractures were identified of which 89 required operative intervention. Of those 89 operations, 7 patients underwent posterior-only approach for transpedicular corpectomy. Levels operated on were at L1 (4 patients), L2 (1 patient), and L4 (2 patients). The mean age was 35 years of age (range 21-56), and mechanism of injury was either motor vehicle accident (5 patients) or fall (2 patients). Initial neurologic exam was ASIA B in 3 patients, ASIA D in 3 patients, and 1 patient was neurologically intact. Mean TLICS on presentation was 6.4 (range 5-8) while mean LSC score was 7.4 (range 7-9). Of patients who were not immediately lost to follow-up on hospital discharge, mean clinical follow-up was 45.3 months (range 18.8-68.6 months) while mean radiographic follow-up was 28.8 months (range 1.3-63.6 months). At last known radiographic follow-up, no patient had gross hardware fracture, pseudoarthrosis, or adjacent segment disease. One patient with the longest radiographic follow-up out to 63.6 months was noted to have some minimal subsidence of his cage with no other change in his other hardware.
Conclusions: A posterior-only approach for transpedicular corpectomy and instrumented fusion is a viable treatment option for lumbar burst fracture which allows for reconstruction of the anterior column while avoiding many of the risks and complications associated with an anterior or combined approach.
Patient Care: This will improve patient care by describing the feasibility of using this technique in patients with traumatic lumbar burst fractures.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of the transpedicular corpectomy as a surgical option, 2) Discuss, in small groups, when an anterior, posterior, or combined approach may be needed, and 3) Identify an effective treatment for traumatic lumbar burst fractures.