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Single-Stage Transpedicular Approach for Circumferential Arthrodesis in Traumatic Lumbar Vertebral Body Burst Fractures


 Background Traumatic vertebral burst fractures can be surgically approached via different approaches (anterior/posterior, or combined). Posterior transpedicular approach (PTA) is a posterior approach that has the advantage of achieving circumferential arthrodesis via single posterior-only approach. The purpose of this study was to analyze our experience with PTA in management of traumatic lumbar burst fractures (TLBFs).
 Methods All consecutive patients with TLBFs managed with PTA over 3 years’ duration were included in this retrospective study. Correction of kyphotic deformity and change in neurologic status were analyzed to assess outcome. Cobb’s angle and American Spinal Injury Association (ASIA) grade were used for this purpose.
 Results There were 12 males and 8 females. Five patients had complete (ASIA-A) while 12 had incomplete injury. The mean preoperative Cobb’s angle was 14.23 degrees that improved to–3.21 degrees postoperatively (mean kyphosis correction: 17.44 degrees). None of the patients developed iatrogenic nerve root injury. There was no perioperative mortality. The mean Cobb’s angle was 1.45 degrees at 36 months’ follow-up. Four patients developed cage subsidence but none required revision surgery. Postoperatively, 13 (65%) patients showed neurologic improvement and none deteriorated. The average ASIA score improved from 2.82 to 4.23. A fusion rate of 96% was observed at last follow-up.
 Conclusion The advantages of PTA including sense of familiarity with posterior approach among spine surgeons, lesser approach-related morbidity, and results comparable to anterior/combined approaches, make the PTA an attractive option for managing TLBFs. Although technically difficult, it can be successfully used for circumferential arthrodesis in the lumbar region without sacrificing nerve roots.