[Minimally invasive surgical management of a bi-pedicular vertebral compression fracture: a case report]

Vertebral compression fractures represent an important part of daily trauma in spine surgery. Their management is codified thanks to the different classifications available to us. The combination of a compression fracture and bi-pedicular involvement of the same vertebra usually leads to extensive surgical management. The main objective of this case report is to share our experience with a minimally invasive osteosynthesis technique performed on this type of fracture. The patient was 61 years old and fell from a 3.5 m high roof. Clinically, he had no sensory-motor deficit. He presented back pain at 8/10 on a visual analogue scale (VAS). The Computed tomography scan revealed a compression fracture of the 4^th lumbar vertebra (L4) type A.3 according to the AO classification. There was also bi-pedicular involvement of L4. He underwent minimally invasive surgical management consisting of a combination of kyphoplasty with percutaneous isolated bilateral intra-pedicular osteosynthesis. We observed a rapid sedation of the pain with a VAS of 2/10 at the first day and 0/10 at 3 months. Bone healing was achieved at 3 months on computed tomography (CT) scan. At 18 months, there was no evidence of secondary displacement of the material. Sagittal and frontal balance was satisfactory. The patient had returned to a clinical state like that prior to the accident. The aim of this case was to propose a less invasive surgical alternative for the management of bi-pedicular vertebral compression fractures. In this case, a combination of kyphoplasty with percutaneous isolated bilateral intra-pedicular osteosynthesis resulted in a rapid recovery after surgery and a return to the pre-accident condition.