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Case series
Use of the SpineJack direct reduction for treating type A2, A3 and A4 fractures of the thoracolumbar spine: a retrospective case series
  1. Giorgio Lofrese1,
  2. Luca Ricciardi2,
  3. Pasquale De Bonis3,
  4. Francesco Cultrera1,
  5. Michele Cappuccio4,
  6. Alba Scerrati3,
  7. Antonio Martucci4,
  8. Antonio Musio3,
  9. Luigino Tosatto1,
  10. Federico De Iure4
  1. 1 Department of Neurosciences, Neurosurgery Division - “M Bufalini” Hospital, Cesena, Emilia-Romagna, Italy
  2. 2 NESMOS, Sapienza University of Rome, Rome, Italy
  3. 3 Neurosurgery, University Hospital S.Anna, Ferrara, Italy
  4. 4 Department of Spine Surgery, Ospedale Maggiore “C.A. Pizzardi”, Bologna, Italy
  1. Correspondence to Dr Giorgio Lofrese, Neurosciences, "M. Bufalini" Hospital, 47521 Cesena, Emilia-Romagna, Italy; giorgio.lofrese{at}


Background Compression injuries of the thoracolumbar spine without neurological impairment are usually treated with minimally invasive procedures. Intravertebral expandable implants represent an alternative strategy in fractures with low fragments’ displacement.

Methods Patients with A2, A3 and A4 fractures of the T10–L2 spinal segment without neurological impairment, fracture gap >2 mm, vertebra plana, pedicle rupture, pedicle diameter <6 mm, spinal canal encroachment ≥50%, and vertebral body spread >30% were treated with the SpineJack device. Patients with pathological/osteoporotic fractures were excluded. Demographic and fracture-related data were assessed together with vertebral kyphosis correction, vertebral height restoration/loss of correction and final kyphosis. The modified Rankin Scale (mRS), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), Smiley–Webster Pain Scale (SWPS) and EuroQol-5D (EQ-5D) were evaluated at 1 (-post), 6 and 12 months (-fup) after surgery. Statistical analysis was performed and p values ≤0.05 were considered significant.

Results Fifty-seven patients were included in the study. Patients aged >60 years reported worse kyphosis correction (<4°) with more postoperative complications, while vertebral plasticity in younger patients, fragmentation-related greater remodeling in A3/A4 fractures, and treatments within 7 days of trauma determined superior wedging corrections, with better EQ-5D-post and mRS-fup. Cement leakages did not affect functional outcome, while female gender and American Society of Anesthesiologists (ASA) score of 3–4 were associated with worse ODI-fup and VAS-fup. Although fracture characteristics and radiological outcome did not negatively influence the clinical outcome, A2 fracture was a risk factor for complications, thus indirectly compromising both the functional and radiological outcome.

Conclusion With spread of <30%, the SpineJack is an alternative to minimally invasive fixations for treating A3/A4 thoracolumbar fractures, being able to preserve healthy motion segments in younger patients and provide an ultra-conservative procedure for elderly and fragile patients.

  • thoracic
  • spine
  • trauma
  • lumbosacral
  • technique

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  • GL and FDI contributed equally.

  • Contributors GL and FDI contributed equally to this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.