Open Access Case report

Safe surgical technique: cement-augmented pedicle screw instrumentation and balloon-guided kyphoplasty for a lumbar burst fracture in a 97-year-old patient

Thomas Freude1*, Benjamin König1, Frank Martetschläger2, Sebastian Siebenlist2, Markus Neumaier2, Ulrich Stöckle1 and Stefan Döbele1

Author Affiliations

1 Department of Traumatology, Eberhard Karls Universität Tübingen, Schnarrenbergstrasse 95, Tübingen, 72076, Germany

2 Department of Traumatology, Klinikum Rechts der Isar, Technische Universität Muenchen, Ismaninger Strae 22, Munich, 80809, Germany

For all author emails, please log on.

Patient Safety in Surgery 2013, 7:3  doi:10.1186/1754-9493-7-3

Published: 8 January 2013

Abstract

Background

During the last few years, an increasing number of unstable thoracolumbar fractures, especially in elderly patients, has been treated by dorsal instrumentation combined with a balloon kyphoplasty. This combination provides additional stabilization to the anterior spinal column without any need for a second ventral approach.

Case presentation

We report the case of a 97-year-old male patient with a lumbar burst fracture (type A3-1.1 according to the AO Classification) who presented prolonged neurological deficits of the lower limbs - grade C according to the modified Frankel/ASIA score. After a posterior realignment of the fractured vertebra with an internal screw fixation and after an augmentation with non-absorbable cement in combination with a balloon kyphoplasty, the patient regained his mobility without any neurological restrictions.

Conclusion

Especially in older patients, the presented technique of PMMA-augmented pedicle screw instrumentation combined with balloon-assisted kyphoplasty could be an option to address unstable vertebral fractures in “a minor-invasive way”. The standard procedure of a two-step dorsoventral approach could be reduced to a one-step procedure.

Keywords:
Thoracolumbar fracture; Augmented screws; Kyphoplasy; Spine fracture in elderly