Percutaneous Kyphoplasty in Traumatic Fractures

Ninety percent of all spinal fractures occur in the thoracolumbar region, and 66% are compression fractures of type A (A1 35%, A2 3.5% A3 27.5%). Type A fractures involve mainly the vertebral body: the posterior column is only insignificantly injured, if at all. The height of the vertebral body is reduced and the posterior ligamentous complex is intact. Translation into the sagittal plane does not occur. These type of injuries are caused typically by axial compression with or without flexion. The incidence of neurological injuries goes up to approximately 32% in burst fractures (type A3) [13]. Although it is a very common fracture, there is no consensus as to a standardised treatment with various opinions regarding the most appropriate treatment for those fractures without neurological deficit and this remains a subject of controversy. Internal fixation offers the possibility of immediate stability and correction of the deformity with the potential visual decompression of neurological structures when needed. With non-operative care, brace or body casts, the same possibility of stabilisation with less correction of the deformity is given [14, 17, 18]. Recent studies comparing long-term results in the treatment of burst fractures found the same results with lesser morbidity for non-operative treatments [21]. Failures after pedicle screw fixation and specifically after removal of instrumentation or after conservative management are possibly due to lesions of the disc and are later due to disc degeneration with decreased anterior column support. Restoration of vertebral height and preservation of the endplatemay prevent the secondary risk of kyphotic deformation and so decrease the risk of chronic pain. In this respect kyphoplasty is an improved technique for the reduction of fractures, for vertebral body height restoration and cement augmentation in the treatment of painful osteoporotic compression fractures with a decreased complication rate compared to vertebroplasty [8, 12]. New calcium phosphate cements which have a good resistance and stability under compression can now be used in association with kyphoplasty, and thus provide a new alternative treatment in non-pathological type A fractures. With this new, mini-invasive percutaneous technique we now have the potential to obtain clinical results comparable with the classic surgical treatment but with less surgical trauma to the patient [1, 19, 20].