Expandable Intravertebral Titanium Implants for Thoracolumbar Burst Fractures Without Neurological Deficits

Objective: A thoracolumbar burst fracture (TLBF) is defined as the failure of the anterior and middle columns of the vertebra due to high-energy trauma, such as motor vehicle collisions and falls from heights. Debate has continued for decades regarding the standard treatment, especially for TLBFs without neurological deficits (TLBF-WONDs). The aim of this study was to understand the role of expandable intravertebral titanium implants (EITIs) in treating TLBF-WONDs.Methods: We included patients aged 18–65 years who presented at our hospital Emergency Department with severe back pain (visual analogue scale [VAS] score ≥ 8), were neurologically intact, were diagnosed with TLBF-WOND by either computed tomography or magnetic resonance imaging, underwent percutaneous bilateral transpedicular EITI implantation, and were followed-up for ≥12 months. Radiological and clinical outcomes were analyzed.Results: Thirty patients satisfied the study inclusion criteria, including 9 men and 21 women, with an average age of 48.2 years. Thirteen A3 and 17 A4 burst fractures were included. The mean duration of hospitalization was 3.3 days. The mean follow-up period was 4.4 years. All patients exhibited significant improvements in radiographical (anterior, middle, and posterior vertebral heights); vertebral kyphotic angle (p<0.001); and functional outcomes (VAS and Oswestry Disability Index scores, p<0.001). One case of cement leakage into the paraspinal muscle was observed; however, no major complications occurred.Conclusion: Percutaneous bilateral transpedicular EITI placement with cement augmentation under local anesthesia may be an effective strategy for the treatment of high-energy traumatic TLBFs with neurological integrity.