Purpose: In recent years, the popularity of percutaneous vertebral augmentation, with vertebroplasty or kyphoplasty, and the volume and rate of procedures are steadily increasing. Although osteoporotic and neoplastic vertebral body fractures are usually regarded as the main indication to such minimally invasive procedures, kyphoplasty can also be a safe and effective treatment in neurologically intact patients with Magerl type A traumatic injuries who are not candidates for surgery. At our institution, which is mainly an emergency hospital, patients are customarily offered the option between kyphoplasty and the traditional triad of prolonged bed rest, external bracing and analgesia when harboring suitable lesions of the thoracolumbar spine. In traumatic fractures, cortical bone is usually violated and is not competent anymore to contain injected cement within vertebral body boundaries. Therefore, we use a modified technique aimed to forestall cement leakage. Concisely, we add intermediate procedural steps to dam up osseous defects by small amounts of cement spread out in a sealing film fashion around the inflatable balloon-like bone tamp which is the distinguishing feature of kyphoplasty. Our technique and results are reported here.

Materials and Methods: From June 2005 to January 2009, 42 hospitalized subjects (aged 18–85 years; men: 23, women: 19) agreed to undergo kyphoplasty because of a traumatic injury involving the spine from T5 through L5. Standard technique was modified as follows. Once the cavity within the vertebral body had been remodeled, the balloon-like bone tamp was temporarily removed. Then, a small amount of doughy cement was injected. Thereafter, the balloon was reinserted and inflated to spread out cement as a sealing film. In the case of comminuted fractures presenting irregular gaps, such sequential steps were repeated several times and cavity lining was obtained in an incremental fashion, beginning in the anterior portion and then going posteriorly.

Results: Mobilization on the second postoperative day was obtained in all cases, provided that no other injury kept the patient bedridden. All subjects reported immediate pain relief. No clinical complications occurred. Radiographic improvement was only slight or moderate.

Conclusion: As has already been pointed out, conservative therapy of vertebral body fractures is neither benign nor risk free as the term seems to imply and its complications are well documented, while vertebral augmentation can produce immediate improvement in a patient's quality of life. At present, such considerations hold true for osteoporotic and neoplastic lesions but several attempts are underway to broaden the use of vertebral augmentation to traumatic injuries too. In this latter regard, our series is the largest one so far reported and confirms that kyphoplasty can be safely and effectively performed after traumatic injuries. Appropriate patient selection and careful injection technique must be implemented for vertebral augmentation to fulfill the promise it seems to hold in traumatic vertebral body compression fractures.

Competing interests: None.

References

1. Morrison WB, Parker L, Frangos AJ, et al. Vertebroplasty in the United States: guidance method and provider distribution, 2001-2003. Radiology 2007;243:166–70.

2. Jensen ME, McGraw JK, Cardella JF, et al. A position statement on percutaneous vertebral augmentation. J Vasc Interv Radiol 2007;18:325–30.