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Published on: November 8, 2024
A Novel Intravertebral Fixation Technique of Lumbar Osteoporotic Vertebral Bipedicular Dissociation Fractures
Raphael Lotan1, Arsan Shpigelman, Oded Hershkovich
1From the Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel (Dr. Lotan and Dr. Hershkovich). Dr. Lotan and Dr. Hershkovich are now with the Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv, Israel, and the Department of Orthopedic Surgery, Bnai Zion Medical Center, Haifa, Israel (Dr. Shpigelman).
Objective:
A significant portion of traumatic spinal fractures involves the thoracolumbar spine. Fracture stabilization using pedicle screws initially demanded fixation of two levels above and below the fractured vertebra to achieve a stable construct. Over the years, a short-segment pedicle screw fixation was found to be adequate. Balloon kyphoplasty (BKP) is commonly used as a minimally invasive treatment for vertebral compression fractures. At times, lumbar burst fractures can extend to the posterior elements. These recently acknowledged subtypes of fracture do not cause posterior column instability other than coronal bipedicular dissociation. BKP alone is inadequate in these cases; a combination of BKP addressing anterior column reduction and support with a middle column stabilization by transpedicular fixation has the potential to treat all fracture elements without losing motion segments through a minimally invasive technique. This study aims to describe this novel concept and technique.
Methods:
Five patients were treated with the intravertebral fixation (IVF) technique for coronal bipedicular dissociation fractures. We describe the surgical technique and review the pertinent literature.
Results:
The IVF technique is clinically safe in stabilizing the specified fractures, with good clinical and functional outcomes.
Conclusion:
IVF is a promising surgical technique and an exciting treatment concept for unique fracture types involving bipedicular coronal dissociation with or without burst fracture. Further studies are required to assess long-term results and possible complications.
Study Design:
Case series for a new surgical technique.
