Stellenwert der Höhenrekonstruktion und der anterioren Stabilisierung bei inkompletten Berstungsfrakturen der Lendenwirbelsäule – eine biomechanische Studie

One of the most common vertebral injuries in young people is the incomplete burst fracture in the thoracolumbar junction after high-speed trauma. The treatment of these vertebral fractures without neurological deficits is still controversial in the literature. Within current recommended surgical methods, a distinction is made between pure dorsal stabilization, ventral stabilization and a combination of both. There are several open surgical techniques, as well as minimal invasive procedures. In recent studies there was always a relevant loss of height and insufficient ventral stabilization with pure dorsal stabilization in the thoracolumbar junction. Also, an additional open ventral stabilization showed an increased perioperative complication rate. Moreover, the data situation is rather insufficient, especially in regard to larger case numbers. The specific objective of this work was to compare different combined minimally invasive surgical methods using the SpineJack®, to evaluate which method offers the best outcome in vertebral elevation and additional ventral stability. In addition, a technique to be developed that could generate standardized vertebral fractures. For this purpose, 28 human vertebral bodies Th11 to L3 were prepared and controlled fractures of the vertebral body L1 were generated. Subsequently, the fractures were treated with four different combined surgical procedures. The SpineJack® with and without cement, was combined with a dorsal minimal invasive surgical procedure. The vertebral bodies were postoperatively loaded with a hydraulic loading machine and the height loss of the vertebral body was determined ventrally, medially and posteriorly. In all 28 spinal columns a fracture of the LWK 1 could be achieved with a so-called "Freefall Tower". Significant anatomical height reconstruction was demonstrated in all groups when SpineJack® was introduced, as opposed to dorsal stabilization alone. Thus, dorsal stabilization in combination with intravertebral reconstruction of a vertebral body has been shown to be a successful surgical procedure, which may also be seen as an alternative to ventral vertebral body stabilization. However, the low number of cases, measurement inaccuracies in the CT evaluation and the median age of the carcasses of 64.9 ± 6.5 years must be considered critically. Moreover, the transferability of test results from biomechanical cadaver studies to in vivo conditions is also difficult. Future experimental and clinical studies are nedded to reach a 78 Summary conclusion on the successful surgical treatment of burst fractures in the thoracolumbar junction.