Fichten A, Peltier J, Lefranc M, Nicot B, Le Gars D (Amiens, France)
Background and purpose
Treatment of thoraco-lumbar spine fracture without neurological deficit remains debated. We prospectively studied a group of 17 patients treated by percutaneous fusion with kyphoplasty and compared it to a group of 13 patients previously treated by classical open surgery for similar fractures.
Methods
A multidisciplinary decisional tree created in our institution was used to determine treatment of non-neurological thoraco-lumbar spine fracture. Each time possible, percutaneous posterior fusion was indicated for A2, A3, B and C-type Magerl classified fracture. Kyphoplasty was added if vertebral kyphosis of fractured level was 15 degrees or more. No complementary external brace was used. Clinical and radiological datas concerning 15 patient s treated with percutaneous fixation associated with kyphoplasty were studied at the time of operation and after with a minimum follow-up of 3 months (3 to 24). Some clinical and radiological datas were compared to an anterior series of patient who were retrospectively indicated of this technique by two independant examiners. Economical costs of both techniques were also compared.
Results
Mean vertebral kyphosis was the same for open and percutaneous procedure preoperatively. Operation time was similar between open and percutaneous technique. Screw misplacements were significantly lower with percutaneous technique. Blood loss was significantly lower and hospital stay was shorter (for patients with isolated spine fracture) for percutaneous technique. Mean correction was better and loss of reduction was lower for patient treated percutaneously. Percutaneous fusion alone is cheaper than open procedure. Associated kyphoplasty create significant additional cost.
Conclusion
Percutaneous posterior fusion associated with kyphoplasty has advantages in management of selected thoraco-lumbar fractures compared to open surgery. Global economical cost is difficult to precise because of fluctuant arithmetic rules in hospital administration. Even if instantaneous cost is higher, added kyphoplasty seems interesting because of less aggressive initial procedure, shortening of hospital stay and better results on radiological follow-up.