Decompression, correction, and interbody fusion for lumbar burst fractures using a single posterior approach

Burst fractures of the lumbar spine with instability or severe kyphosis are best served by surgical treatment. The question as to how these fractures should be approached and stabilized (anteriorly, posteriorly, or combined anteroposteriorly) is controversial. We performed decompression, correction, and interbody fusion using a single posterior approach for Denis type B or C lumbar burst fractures with severe kyphosis. The operative technique is as follows: after partial laminectomy, the bone fragment, which had migrated into the spinal canal, is impacted into the posterior wall of the vertebral body. After curetting the injured disk, bone chips and adapted lamina are inserted into the disk space for anterior support. Five Denis type B or C burst fractures demanding >20 degrees kyphosis correction were treated by this procedure. Mean follow-up was 41 months. We evaluated neurologic assessment and localized kyphotic angle. The neurologic function of all 5 patients improved by at least 1 grade, as measured by the Frankel grading scale. Mean values of localized kyphosis improved from a mean 23.0. before surgery to -3.0 degrees after surgery. At follow-up examination, average regional kyphosis was -2.4 degrees . No implant failure was observed at follow-up. Bony fusion was achieved in all patients. The advantages of this operative procedure are it is safe for the neural structures and complete spinal canal decompression and kyphosis correction are achieved, while providing anterior support and posterior stabilization.