Manual Reduction, Subpedicle Approach, and Body Cages to Treat Burst Fracture

Abstract

Thoracolumbar (TL) burst fractures occasionally result in severe instability, acute or delayed neurological dysfunction and require surgical intervention. Burst fractures can be reduced by manual reduction first and the following surgical approaches including anterior, posterior, or both have individual advantages and limitations. Even transpedicular decompression and augmentation with the body cages and short-segment fixation (TpBA) are regarded successful, yet they are limited in their ability to decompress the contralateral spinal cord and bilateral procedures are necessary. Thus, a posterior far-lateral subpedicle approach to open the lateral vertebral cortex window, creating a tunnel to remove retropulsed bony fragments and pass body cages for full-body augmentation (SpBA) to treat burst fracture was herein reported. The characteristics of SpBA include unilateral approach, direct decompression, short operation time, and no posterior instrumentation. While adjacent disc injury and degeneration may occur in burst fractures, Li’s short-term results indicate that SpBA is effective in preventing its adverse effects. This chapter describes the detailed advanced techniques and classification of the results obtained by a professional team manual reduction for post-traumatic kyphosis. The unilateral subpedicle approach with body cages and cementation without screw instrumentation rendering a minimally invasive solution for spinal burst fractures was demonstrated.