2019 Volume 24 Issue 2 Pages 127-132
We present a case of severe lumbar burst fracture treated with percutaneous uniplanar monoaxial pedicle screw fixation.
A 34‒year‒old woman fell from the third floor and was brought to our hospital in an ambulance. Initial computed tomography revealed a T12 spinous process fracture, L1 burst fracture, and sacral fracture at the S3 level. In addition, a right distal radius fracture and fractures in both calcanei were confirmed. Both lower extremities were numbed by the injury but were relieved within a day. The L1 vertebral body injury had a load sharing classification (LSC) score of 7 points.
Minimally invasive percutaneous pedicle screw fixation was performed, one above and one below the L1 burst fracture, using uniplanar monoaxial screws via the posterior approach. This improved the fragment occupancy rate for the spinal canal from 60 to 16%.
The best treatment for thoracolumbar burst fractures remains a matter of debate. The use of percutaneous pedicle screws for posterior spinal stabilization seems to be an effective method for thoracolumbar fractures. However, polyaxial screws can cause difficulties in obtaining a good correction, because the reduction force cannot be directly transmitted to the fractured vertebra. Percutaneous monoaxial screws are being developed to provide satisfactory reduction. Minimally invasive systems enable a severe burst fracture with LSC score of 7 points that requires anterior reconstruction, as in this case, to be treated with a posterior approach alone.
