Kyphoplasty Solves Stabilization and Pain Control Inadequately Treated via Prior Hartshill Rectangle for Thoracolumbar Burst Fracture

Abstract

Surgical management of spinal burst fractures has progressed to include minimally invasive techniques as preferred modalities of treatment. Burst fractures with indications for surgical treatment either through instability or intractable pain classically have required pedicle screw fixation, which requires extensive dissection resulting in postoperative pain and significant recovery time, and also requires longer operative times with more potential blood loss. Balloon kyphoplasty is an established percutaneous technique that can provide quick pain relief for patients with intractable pain following compression and burst fractures, and vertebral body height can also be restored. In the present case, a female patient was seen in the emergency room with intractable pain and a dehiscent thoracolumbar incision after recently undergoing surgery with placement of a Hartshill rectangle and sublaminar wires at another institution for a T12 burst fracture (AO classification [AO] A4 and thoracolumbar injury classification and severity score [TLICS] 4) caused by a motor vehicle accident. Imaging identified an acute unhealed fracture at T12 and other vertebrae with questionable lesions. She underwent surgery to remove the Hartshill construct, stabilize the fracture, biopsy lesions (T7, T10, L2, and L4), and debride and close the wound. Following hardware removal, kyphoplasty was then performed through the open exposure at T12, which could have otherwise been done percutaneously. The patient experienced immediate and complete resolution of her pain associated with the fracture and had no neurological deficits. Modern minimally invasive techniques including kyphoplasty should be favored when indicated as alternative treatment options over more invasive treatment modalities, as they lead to quicker resolution of pain and recovery when compared to techniques requiring a large exposure.

Keywords: burst fracture; hartshill rectangle; kyphoplasty; minimally invasive; percutaneous; spine surgery; thoracolumbar.