Transpedicular bone grafting as a supplement to posterior pedicle screw instrumentation in thoracolumbar burst fractures.

The objective of the present study was to investigate whether transpedicular bone grafting as a supplement to posterior pedicle screw fixation in thoracolumbar fractures results in a stable reconstruction of the anterior column, that allows healing of the fracture without loss of correction. Posterior instrumentation using an internal fixator is a standard procedure for stabilizing the injured thoracolumbar spine. Transpedicular bone grafting was first described by Daniaux in 1986 to achieve intrabody fusion. Pedicle screw fixation with additional transpedicular fusion has remained controversial because of inconsistent reports. A retrospective single surgeon cohort study was performed. Between October 2001 and May 2007, 30 consecutive patients with 31 acute traumatic burst fractures of the thoracolumbar spine (D12-L5) were treated operatively. The mean age of the patients was 45.7 years (range: 19-78). There were 23 men and 7 women. Nineteen thoracolumbar fractures were sustained in falls from a height; the other fractures were the result of motor vehicle accidents. The vertebrae most often involved were L1 in 13 patients and L2 in 8 patients. According to the Magerl classification, 25 patients sustained Type A1, 4 Type A2 and 2 Type A3 fractures. The mean time from injury to surgery was 6 days (range 2-14 days). Two postoperative complications were observed: one superficial and one deep infection. Mean Cobb's angle improved from +7.16 degrees (SD 12.44) preoperatively to -5.48 degrees (SD 11.44) immediately after operation, with a mean loss of correction of 1.00 degrees (SD 3.04) at two years. Reconstruction of the anterior column is important to prevent loss of correction. In our experience, the use of transpedicular bone grafting has efficiently restored the anterior column and has preserved the post-operative correction of kyphosis until healing of the fracture.