Possibilities of transpedicular reposition of the spine. A clinical case

Abstract

Introduction. The effectiveness of restoring the vertical dimensions of the bodies of damaged vertebrae during closed decompression of the spinal canal, depending on the damage to the bone and ligamentous formations of the spine and the time since the injury, remains controversial. Objective. Using a clinical example, to show the possibilities of performing hardware reposition of the L_I vertebra body with the achievement of calculated individual targets, at a time traditionally considered late for the ligamentotaxis effect. Materials and methods. A 43-year-old patient with a compression comminuted fracture of the L_I vertebra, type A4 according to AOSYPE, D degree neurological disorders according to ASIA. Results. After calculating the real and theoretical vertical dimensions of the damaged vertebra with adjacent discs, as the first stage of the planned decompression-stabilizing operation, on the 23^rd day after the injury, the spine was repositioned and fixed with a transpedicular system, which ensured, without decompression, the restoration of the anterior vertebral body size from 59.3% to 91.6%, the posterior from 71.4% to 97.4%, and the correction of angle of deformation from 17.2° to –2.5° (by 19.7°) with a decrease in the degree of compression of the spinal canal from 58.3% to 23.4%, followed by regression of neurological disorders. Discussion. Described are the restoration of anatomical parameters of a damaged vertebra when using a closed reposition at different times after injury. Conclusion. Clinical observation demonstrates the possibility of effective reposition of a vertebral fracture with restoration of the calculated body sizes, interbody spaces and segmental angle within three weeks from the moment of injury, which is traditionally not recommended for closed indirect decompression of the spinal canal due to ligamentotaxis. The use of preoperative planning and step-by-step repositional maneuvers made it possible to achieve anatomical correction of deformity, closed decompression of the spinal cord and stable fixation of the spine.