Jose Aso-Escario, Laura Gonzalez Garcia, Alberto Aso-Vizan, Jose-Vicente Martinez-Quiñones, Fabian Consolini, Ricardo Arregui-Calvo
Background: The transpedicular approach, fitting of an expandable cage, and posterior fusion, is a procedure that enables the neurosurgeons to treat severe burst fractures through a familiar access for them. This treatment has been described for selected patients in order to avoid the morbidity associated with the anterior approaches (vascular injury, aspiration, pleural effusions effusion, pneumothorax, decreased pulmonary function, etc).
Methods: We review the Literature about upper thoracic fractures treated with this procedure, analyze the indications and surgical technique, and present the case of a severe T4 burst fracture operated upon by transpedicular corpectomy, self-expanding cage and posterior transpedicular fusion.
Results: Literature review showed a relative rarity of reports of non-pathological fractures treated by this procedure in the upper thoracic region (about 7 upper spine fractures reported with a similar treatment to ours). A lesser incidence of complications, in comparison to anterior routes, is reported. According to the review and our experience, the procedure can provide both an effective decompression as a solid stabilization, along with less postoperative complications than the anterior routes.
Conclusions: Upper thoracic spine fractures have only rarely been treated with transpedicular posterior approach. Neurosurgeons are familiar with this route. Therefore, more similar cases need to be communicated, in order to assess the reliability and safety of the procedure in selected patients, eventually increasing the indications of the procedure and progressively involving upper levels of thoracic spine.
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