Height Restoration for Vertebra Plana Using a Mechanical Lamellar Vertebral Body Reduction Device: 2-Dimensional Operative Video

Abstract

Compression fractures of thoracolumbar vertebra are the most common vertebral fracture. 1 Associated with osteoporosis, the compression can progress until reach vertebra plana and cause a kyphosis. 2 The reduction of the fresh fracture and restoration of the height are the purposes of the kyphoplasty. 3 We present a modified technique adapted for the treatment of vertebral plana using a mechanical flexible lamellar vertebral body reduction device (Tektona, Spinart). 4 We present the case of a 77-year-old woman with back pain after a fall. The radiological investigations show a compressive fracture type AO A1 of T7. After an initial conservative management, the patient presented persistence of the pain with a visual analog scale of 9/10 and progression of the fracture at the 2-week follow-up. On the x-ray, focal kyphosis with vertebra plana was observed. A kyphoplasty for pain management and kyphosis correction was performed. The patient consented to the procedure. A bipedicular approach to the vertebra was performed. The correction of the height was done using 2 mechanical devices. The lamellar device allowed a progressive height restoration of the fracture. On one side, the cannula was used as a support to maintain the correction during the contralateral cementing. The postoperative imaging confirmed a maintained vertebral restoration with kyphosis correction. At 1 year, the patient reported a pain at 1 of 10 on the visual analog scale. In our opinion, this technique is adapted for fresh osteoporotic vertebral compression fractures. Surgical experience in osteoporotic fracture treatment and kyphoplasty is recommended before the management of vertebra plana.