Management of Unstable Thoracolumbar Burst Fractures Using a Titanium Mesh Cage and the Kanada System: A Report of 21 Cases

Gregory C Wiggins, MD
Michael J. Rauzzino, MD
Christopher I. Shaffrey, MD
Russ P. Nockels, MD (Detroit, MI)
Richard Whitehill, MD
Tord D Alden, MD
Mark E. Shaffrey MD, (Charlottesville, VA)

Introduction:

This study was conducted to determine the safety, efficacy and complication rate of the anterior approach with the use of a new titanium mesh interbody fusion cage in the treatment of unstable thoracolumbar burst fractures. This technique is compared to the senior author's (CS,RW,MS) previously published results in the management of unstable thoracolumbar burst fractures.

Methods/Results:

Between 1996 and 1999, 21 patients average age 34 (16–59) with unstable thoracolumbar (T12–L3) burst fractures underwent anterolateral decompression with placement of a titanium cage and Kaneda device. Eleven of the 21 patients had a neurologic deficit and all patients improved at least one Frankel grade (average 1.2 grades) with average follow–up 15.0 months (2–31). Canal compromised averaged 65.5% (25–90). Preoperative kyphosis averaged 18.8 degrees and postoperative kyphosis averaged 0.1 degree (–1O to 16). Operative time averaged 318 minutes (250–375). Blood loss averaged 781 ml (400–1100) while blood replacement averaged 363 ml (0–1000).

Conclusion:

There was statistically significant (p<.05) improvement in Denis Pain Scale and trend toward improved postoperative kyphosis and Denis Work Scale. The addition of the titanium mesh cage to the anterior technique allows the patient's own bone to be harvested from the corpectomy site, eliminating the need for iliac crest harvest. The use of the cage in association with the Kaneda device allows for improved kyphosis correction and restoration of normal sagittal alignment associated in addition to improved functional outcomes.