Traitement chirurgical mini-invasif d’une fracture vertébrale par compression avec atteinte bi-pédiculaire: rapport de cas

Vertebral compression fractures represent an important part of daily trauma in spine surgery. Their management is codified thanks to the different classifications available to us. The combination of a compression fracture and bi-pedicular involvement of the same vertebra usually leads to extensive surgical management. The main objective of this case report is to share our experience with a minimally invasive osteosynthesis technique performed on this type of fracture. The patient was 61 years old and fell from a 3.5 m high roof. Clinically, he had no sensory-motor deficit. He presented back pain at 8/10 on a visual analogue scale (VAS). The Computed tomography scan revealed a compression fracture of the 4(th) lumbar vertebra (L4) type A.3 according to the AO classification. There was also bi-pedicular involvement of L4. He underwent minimally invasive surgical management consisting of a combination of kyphoplasty with percutaneous isolated bilateral intra-pedicular osteosynthesis. We observed a rapid sedation of the pain with a VAS of 2/10 at the first day and 0/10 at 3 months. Bone healing was achieved at 3 months on computed tomography (CT) scan. At 18 months, there was no evidence of secondary displacement of the material. Sagittal and frontal balance was satisfactory. The patient had returned to a clinical state like that prior to the accident. The aim of this case was to propose a less invasive surgical alternative for the management of bi-pedicular vertebral compression fractures. In this case, a combination of kyphoplasty with percutaneous isolated bilateral intra-pedicular osteosynthesis resulted in a rapid recovery after surgery and a return to the pre-accident condition.