One-Stage Posterior Open Fixation with SpineJack Expansion Kyphoplasty for Unstable A4 Complete Thoracolumbar Burst Fracture with Neurological Deficit: A Proof-of-Concept Case Series
Year: 2026
Type: article
Abstract: Objectives: Usually, complete burst fractures of the thoracolumbar spine responsible for neurological deficit are managed with posterior open long-segment fixation, laminectomy, and second-stage anterior corpectomy. Although SpineJack expansion kyphoplasty allows for one-stage posterior-only restoration of the anterior and middle columns of the spine, to date, it has not been employed for complete burst fracture with neurological deficit. Materials and Methods: Review of all cases of AO Spine A4 thoracolumbar complete burst fractures with neurological deficit treated by a single senior spine surgeon at Sainte-Anne Military Teaching Hospital using the same surgical procedure-SpineJack expansion kyphoplasty, posterior pedicle screw fixation, and posterior decompression-between November 2023 and October 2025. Results: There were five patients with a mean age of 42.6 ± 16.8 years. Levels involved were T12, L1, L2, and L3 (patients 1-4), and combined L2L3 in a last severe trauma case (patient 5). Neurological deficit was classified as American Spinal Injury Association (ASIA) C in four cases, and ASIA B in patient 5. Mean preoperative loss of vertebral body height was 54 ± 10.3% and regional kyphosis 22.8 ± 4.4 degrees. Mean postoperative length of stay was 16.2 ± 24.6 days, and 5.3 ± 2.5 days excluding patient 5. Patients 1 to 4 returned to work after a mean delay of 3.3 ± 0.5 months. At the 1-year follow-up, the mean visual analog scale score was 2.8 ± 0.5, the mean Oswestry Disability Index was 7.6 ± 5.2, the mean segmental kyphosis was 4.2 ± 6.9 degrees, and the mean loss of vertebral body height was 11.2 ± 8.9%. Conclusion: SpineJack expansion kyphoplasty combined with short-segment monoaxial pedicle screw fixation and laminectomy is a possible one-stage surgical treatment option for complete burst fracture of the thoracolumbar spine with neurological deficit.
Source: Asian Journal of Neurosurgery
Author: Nathan Beucler
Institution: Hôpital d'Instruction des Armées Sainte-Anne
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7125511229