Samy Chaachoua-Mouffak, Maureen Pere, Josephine Mas, Sarah Uneisi, Gael Kerschbaumer, Jérôme Tonetti, Mehdi Boudissa
One patient (3.8%) required secondary corpectomy. Significant postoperative correction of LK, RK, and VH was observed. At 1 year, RK remained stable, whereas a moderate but significant loss of LK correction (p = .002) and VH restoration (p = .004) occurred, without functional impact. Median ODI was 5 [0.5-16] and median VAS was 0.5 [0-1.75]. Operative sequence did not influence radiological or functional outcomes.
BACKGROUND: Thoracic and lumbar fractures with a Load Sharing Classification (LSC) score ≥ 7 are considered at high risk of failure after isolated short posterior fixation, which historically led to systematic anterior reconstruction by corpectomy with substantial morbidity. Minimally invasive vertebral body expansion combined with short posterior fixation may restore anterior column support while limiting surgical aggressiveness. However, data remain limited for fractures with high LSC scores. This study addressed the following questions: (1) Does the combined strategy reduce the failure rate in thoracolumbar « burst » fractures with LSC ≥ 7? (2) Does it provide significant and sustained radiological correction at 1 year? (3) Are functional outcomes satisfactory at final follow-up?
HYPOTHESIS: The combination of percutaneous short posterior fixation and anterior vertebral body expansion reduces the expected failure rate in fractures with LSC ≥ 7 while providing satisfactory radiological and functional outcomes.
PATIENTS AND METHODS: A retrospective single-center study included 26 consecutive patients presenting with thoracic or lumbar burst fractures and LSC ≥ 7, treated between 2018 and 2025 with percutaneous short-segment posterior fixation combined with vertebral body expansion using SpineJack®. Failure was defined as secondary corpectomy or implant removal due to mechanical failure. Radiological parameters-local kyphosis (LK), regional kyphosis (RK), and vertebral height (VH)-were measured preoperatively, immediately postoperatively, and at 12 months. Functional outcomes included the Oswestry Disability Index (ODI) and visual analog scale (VAS). The minimum follow-up was 12 months.
RESULTS: One patient (3.8%) required secondary corpectomy. Significant postoperative correction of LK, RK, and VH was observed. At 1 year, RK remained stable, whereas a moderate but significant loss of LK correction (p = .002) and VH restoration (p = .004) occurred, without functional impact. Median ODI was 5 [0.5-16] and median VAS was 0.5 [0-1.75]. Operative sequence did not influence radiological or functional outcomes.
DISCUSSION: In thoracolumbar burst fractures with high LSC scores, the combined minimally invasive strategy was associated with a low failure rate and maintenance of regional sagittal alignment at 1 year. Restoration of anterior column support using vertebral expansion may represent an alternative to systematic anterior reconstruction. Comparative prospective studies are warranted.
LEVEL OF EVIDENCE: IV: Retrospective single-center study.