Osteoporotic burst fracture-clinical, radiological and functional outcome of three-column reconstruction using single posterior approach (Instrumentation, Corpectomy, Arthroscope Assisted Transpedicular Decompression and Mesh Cage)

PURPOSE: To evaluate a novel effective procedure utilizing three-column reconstruction via a posterior approach with a technique that utilizes an arthroscope to visualize the anterior surface of the dura during decompression. METHODS: A Prospective Study. 80 Osteoporotic vertebral burst fracture patients with similar demographic data managed by three-column reconstruction through single posterior approach surgery: Pedicle screw fixation, Corpectomy, Arthroscope Assisted Transpedicular Decompression (AATD) and Fusion (Mesh Cage + Bone grafting). Preoperative and postoperative clinical parameters (Visual Analog Score VAS, swestry Disability Index ODI, neurlogy, radiological parameters and surgical variables were recorded analysed. RESULTS: No significant differences in demographic data. Significant improvement was noted in VAS (pre-operative, 7.90 ±0.60; final follow-up 2.90 ± 0.54) and ODI (preoperative, 77.10 ± 6.96; final follow-up 21.30 ± 6.70). Neurological improvement was noted in 74 patients (Frankel grade E) while six patients remained non-ambulatory (Frankel grade C). Significant improvement was noted in local kyphosis angle (preoperative, 22.14 ± 2.60; postoperative, 10.40 ± 1.40) with a 10% loss of correction (2.5 ± 0.90) at final follow-up. Implant failure in two patients and proximal junctional failure in two patients managed with revision surgery. No iatrogenic dural or nerve injury. CONCLUSIONS: Osteoporotic Burst fracture can be managed with single posterior surgery, three-column reconstruction with mesh cage. It provides a significant improvement in clinical, radiological and functional outcomes. The arthroscope can improve a surgeon's operative field and magnification thereby ensuring complete decompression without injuring the dura or spinal cord.