A one-session circumferential reconstruction in thoracic and lumbar spine fractures using a small expandable cage

Circumferential reconstruction of thoracic and lumbar vertebrae is most frequently performed in two sessions. The authors assessed feasibility, safety and results of a surgical technique in which the use of a small cage allows a less invasive strategy. In addition, since the authors perform urgent decompression in specific cases of spinal cord injury, feasibility of this technique in emergency was verified.

In two Neurosurgical Departments, between May 2001 and May 2006, 62 patients with thoracic or lumbar fractures were operated on using this technique. X-rays were performed postoperatively and around 45 days from surgery. Three-dimension-computed tomography (3D-CT) scans were performed at 3, 6 and 12 months. Neurological evaluations were repeated at every outpatient visit. After screw insertion at the adjacent levels and traditional transpedicular circumferential decompression, further bone is removed to excavate a niche in the vertebral body and the contiguous discs are removed. The expandable cage, filled with bone fragments, is inserted horizontal or oblique laterally to the sac and applied vertical inside that niche and then expanded. The circumferential stabilization is completed with bone grafting and posterior instrumentation.

3D-CT scans showed sound fusion and no manifest correction loss. Nineteen patients improved at least one grade in the ASIA scale and 11 gained neuromeric levels.

This technique, fairly undemanding and feasible also in emergency, proved to be safe and resistant. Two-year follow-up demonstrated thriving fusion and steady alignment. It is a valuable surgical therapy to selected cases of burst fracture.