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

Abstract 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. 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. 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%. 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.