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Journal of Neurosurgery: Case Lessons logoLink to Journal of Neurosurgery: Case Lessons
. 2025 Apr 7;9(14):CASE24821. doi: 10.3171/CASE24821

Applications of the SpineJack device in the surgical management of type A4 lumbar burst fractures without neurological deficit: illustrative cases

Giorgio Cracchiolo 1,2,✉, Stefano Ticca 1, Nicholas Giulio Raccagni 1,2, Emanuele Costi 1, Angela Dele Rampini 1, Luigi Alberto Andrea Lanterna 1, Andrea Fanti 1
PMCID: PMC11976018  PMID: 40194452

Abstract

BACKGROUND

Type A4 lumbar burst fractures are severe spinal injuries typically treated with posterior pedicle screw constructs, with or without corpectomy. However, traditional approaches can be highly invasive and are often limited in their ability to reconstruct the anterior column. The SpineJack device offers a minimally invasive alternative or complement to posterior fixation.

OBSERVATIONS

Four neurologically intact patients with lumbar type A4 fractures were treated using the SpineJack device, either alone or in combination with different posterior fixation techniques. Clinical and radiological outcomes were evaluated preoperatively, postoperatively, and at the 1-year follow-up. The procedure led to significant pain relief and rapid mobilization for all patients. Radiologically, it restored vertebral body height (VBH), increased spinal canal patency, and corrected preoperative deformities, with minimal loss of correction at follow-up.

LESSONS

The SpineJack device is a viable, less invasive alternative to traditional pedicle screw constructs and serves as an effective adjunct for stabilization, potentially replacing corpectomy in some cases. It restores VBH and alignment, maintains load-bearing capacity, and reduces the need for additional hardware. Further research is needed to evaluate long-term outcomes, especially in younger patients.

https://thejns.org/doi/10.3171/CASE24821

Keywords: lumbar burst fractures, surgical management, neurologically intact, SpineJack, A4 fractures, minimally invasive spine surgery

ABBREVIATIONS: AP = anteroposterior, NRS = numeric rating scale, ODI = Oswestry Disability Index, PMMA = polymethylmethacrylate, RKA = regional kyphosis angle, RLA = regional lordosis angle, VBH = vertebral body height.

Lumbar fractures represent the most common type of spinal column injury, with burst fractures accounting for nearly two-thirds of these cases.1–3 Among them, complete burst fractures, classified as type A4 by the AO Spine system, are characterized by significant vertebral body fragmentation, involving both endplates and the posterior wall.4 Despite the severity of these injuries, approximately 30%–50% of patients with burst fractures remain neurologically intact.5 In such cases, the decision to pursue surgical intervention remains controversial and is typically considered when there is substantial comminution or disruption of the posterior ligamentous complex.6,7 Traditionally, surgical management has centered around posterior short and long pedicle screw constructs, with corpectomy performed in cases of severe vertebral body comminution.1 However, these procedures are associated with limitations, such as extensive soft tissue damage, higher complication rates, prolonged recovery periods, and suboptimal restoration of vertebral body anatomy and biomechanics.8,9 These limitations have driven the evolution of minimally invasive surgical techniques, which aim to minimize the downsides of open procedures while still achieving comparable outcomes.10 A significant advancement in this field is the SpineJack device (Stryker), a craniocaudally expandable implant designed to restore vertebral body height (VBH) and stabilize fractures with the assistance of high-viscosity polymethylmethacrylate (PMMA) cement augmentation.11 In this study, we present 4 illustrative cases to highlight the diverse applications of the SpineJack device in the surgical management of traumatic lumbar type A4 fractures in neurologically intact patients.

Illustrative Cases

Clinical History, Postoperative Course, and Follow-Up

Four neurologically intact patients with severe lumbar type A4 fractures presented to our emergency department. Each patient underwent comprehensive physical assessments and detailed imaging to guide their treatment plans. Preoperative, postoperative, and 1-year follow-up measurements were obtained using CT scans and standing radiographs. Measurements included the regional kyphosis angle (RKA), defined as the angle between the superior endplate of the vertebra above the fracture and the inferior endplate of the vertebra below the fracture. The anteroposterior (AP) diameter of the spinal canal was measured as the distance between the retropulsed posterior vertebral body wall and the ventral surface of the lamina. The average VBH values of the anterior, middle, and posterior columns were calculated by measuring the vertical distances between the fractured vertebra’s superior and inferior endplates at the pedicles and midline. For fractures located in the lordotic segments of the spine, such as L4, the regional lordosis angle (RLA) was also considered. Unlike RKA, the goal for RLA is to increase the angle to restore lordosis.

Case 1

A 38-year-old woman sustained an L4 type A4 fracture in a motor vehicle accident. She presented with severe low back pain (numeric rating scale [NRS] score 8/10). Initial imaging showed an RLA of 12.8°, an AP canal diameter of 9 mm, and VBH values of 14 mm (anterior), 11.5 mm (middle), and 19.5 mm (posterior) (Fig. 1A–C). Following treatment with a stand-alone SpineJack device, the RLA was corrected to 19.7°, representing a 54% gain in lordosis. She was discharged on postoperative day 3, ambulatory, with mild residual pain (NRS score 3/10), which resolved completely by 6 months. At the 1-year follow-up, CT showed an AP canal diameter of 12 mm (+33%), a slight loss in RLA correction to 18° (−8.6%), and increased VBH values of 22 mm (anterior), 19.2 mm (middle), and 23 mm (posterior), showing improvements of +57%, +67%, and +18%, respectively (Fig. 1D–F). At the 2-year follow-up, a standing radiograph showed a mild loss in RLA to 16.4° (Fig. 1G), and in terms of disability and quality of life, she had an Oswestry Disability Index (ODI) score of 15, indicating minimal disability, and an EQ-5D score of 0.823.

FIG. 1.

FIG. 1.

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Case 1. Preoperative axial, coronal, and sagittal CT scans (A–C) showing marked posterior wall retropulsion, a high degree of vertebral body fragmentation, and height loss. One-year follow-up axial, coronal, and sagittal CT scans (D–F) demonstrating improved retropulsion and restoration of VBH. Two-year follow-up standing radiograph (G) showing maintained alignment.

Case 2

A 51-year-old man sustained L2 and L4 type A4 fractures as well as an L5 type A1 fracture in a motor vehicle accident (Fig. 2). He presented with maximal back pain (NRS score 10/10). Imaging showed a preoperative RKA of 6° at L2 and RLA of 34° at L4, with AP canal diameters of 11.3 and 8.3 mm, respectively. VBH values at L2 were 24 mm (anterior), 20 mm (middle), and 25 mm (posterior), while at L4, they measured 26 mm, 21.2 mm, and 24.1 mm, respectively. Treatment involved stand-alone SpineJack devices at L2 and L4, combined with vertebroplasty at L5. During surgery, there was paravertebral cement leakage at L4, without any clinical sequelae. Postoperative corrections led to an RKA of 0.5° at L2 (+92%) and RLA of 26° at L4 (−24%). He was discharged on postoperative day 7, ambulatory and pain free. At the 1-year follow-up, CT showed that the AP diameters increased to 11.6 (+3%) at L2 and 11.9 mm (+43%) at L4. RKA correction was reduced to 4.7° at L2, and RLA correction improved to 30.50° at L4. VBH remained stable at L2 (21.5 mm, 20.2 mm, and 25.2 mm; −10.4%, +1%, and +0.8%, respectively), and at L4, it showed minor reductions (24.7 mm, 20.6 mm, and 24 mm; −5%, −2.8%, and −0.4%, respectively) (Fig. 3A–D). At the 2-year follow-up, a standing radiograph showed that at L2, the RKA was improved to 1.05°, and at L4, there was a mild loss of RLA to 27.69° (Fig. 3E), with the patient having an ODI score of 20 and an EQ-5D score of 0.797.

FIG. 2.

FIG. 2.

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Case 2. Preoperative axial CT scans showing moderate posterior wall retropulsion at L2 (A) and a significant decrease in spinal canal patency at L4 (B). Preoperative coronal and sagittal CT scans (C and D) highlighting a moderate degree of fragmentation at L2 and L4, along with a mild compression fracture at L5.

FIG. 3.

FIG. 3.

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Case 2. One-year follow-up axial CT scans (A and B) demonstrating improved spinal canal patency at L2 and L4. One-year follow-up coronal CT scan (C) showing restoration of vertebral body integrity at L2 and L4, a right paravertebral cement leakage at L4, and a vertebroplasty at L5. One-year follow-up sagittal CT scan (D) showing improved canal patency and good alignment. Two-year follow-up standing radiograph (E) showing maintained alignment.

Case 3

A 59-year-old man sustained injuries from a cliff fall and experienced severe low back pain (NRS score 9/10) and multiple skin lacerations. Imaging showed an L3 type A4 fracture with significant posterior wall retropulsion and vertebral height loss (Fig. 4A–C). Preoperative measurements included an RKA of 14.5°, an AP canal diameter of 5 mm, and VBH values of 21.5 mm (anterior), 12.3 mm (middle), and 24.3 mm (posterior). Treatment involved posterior fixation with monoaxial screws and SpineJack implantation. The postoperative RKA was 10.2° (+30%). The patient’s residual pain (NRS score 4/10) at discharge, attributed to an acetabular fracture, resolved by 6 months. At the 1-year follow-up, CT showed a loss of RKA correction to 13° (−27%), an increased AP diameter to 7.7 mm (+54%), and VBH values of 26.9 mm (anterior), 21 mm (middle), and 26.6 mm (posterior), reflecting improvements of +25%, +71%, and +9.5%, respectively (Fig. 4D–F). At the 2-year follow-up, the standing radiograph showed an improvement of the RKA to 11.26° (Fig. 4G), and the patient had an ODI score of 2 and an EQ-5D score of 0.852.

FIG. 4.

FIG. 4.

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Case 3. Preoperative axial, coronal, and sagittal CT scans (A–C) showing severe VBH loss, posterior wall retropulsion, and moderate osseous fragmentation. One-year follow-up axial, coronal, and sagittal CT scans demonstrating marked improvement in VBH and spinal canal patency following posterior fixation and the use of the SpineJack device (D–F). Two-year follow-up standing radiograph (G) showing improved alignment.

Case 4

A 48-year-old man fell from a second floor, sustaining an L1 type A4 fracture. The patient presented with maximal low back pain (NRS score 10/10). CT showed severe fragmentation, posterior wall retropulsion, and an RKA of 16.08° (Fig. 5A and B). Treatment included percutaneous polyaxial pedicle screw placement and SpineJack implantation, achieving postoperative RKA correction to 2.9° (+83%) (Fig. 5C). He was discharged on postoperative day 5 with minimal pain (NRS score 2/10), which resolved by 6 months. At the 6-month follow-up, a CT scan showed an improvement in the AP canal diameter from 8.6 mm to 12.5 mm (+45%). The RKA improved from 16.08° to 2.91° (+81%), and the anterior, middle, and posterior VBH values improved from 10.7 mm, 12.86 mm, and 21.66 mm to 19.86 mm, 20.2 mm, and 24.66 mm, respectively, reflecting increases in percentage of +85%, +57%, and +13.4% (Fig. 5C and D). At the 1-year follow-up, a standing radiograph showed a mild loss of correction to an RKA of 6.19° (Fig. 5E). The patient had an ODI score of 0 and an EQ-5D score of 1, indicating no disability and perfect health status.

FIG. 5.

FIG. 5.

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Case 4. Preoperative coronal and sagittal CT scans (A and B) showing significant local kyphosis and vertebral height loss. Postoperative coronal and sagittal CT scans (C and D) showing vertebral body reconstruction and kyphosis reduction. One-year follow-up radiograph (E) confirming maintenance of alignment achieved intraoperatively with posterior fixation and the SpineJack device.

Surgical Technique and Intraoperative Workflow

The procedure is performed under general anesthesia, with the patient positioned prone on transverse gel rolls at the level of the thorax and pelvis, permitting reduction of the kyphotic deformity by allowing the abdomen to sag between the two rolls. Throughout the operation, intraoperative navigation using the O-arm system (Medtronic) is utilized. After draping the sterile surgical field, two small paramedian percutaneous incisions are made through the paravertebral muscles to allow guidewire access to the vertebral body via the pedicles. The pedicles are then carefully reamed to create space for the template. Once the size and position are confirmed, the template is replaced with the unexpanded implant, which is centrally positioned within the fractured vertebral body. Under fluoroscopic guidance, the implant is expanded in a craniocaudal direction. On achieving satisfactory expansion and fracture reduction, the SpineJack is locked in place using a gear-driven mechanism. Next, high-viscosity PMMA cement is injected through the same trocars, with approximately 3.6 mL applied to each side. If any cement leakage is detected, the procedure is immediately halted. For patients with multiple burst fractures, additional percutaneous incisions can be made to insert more SpineJack implants at other levels, following the same technique. In cases requiring both indirect and direct distraction, posterior instrumentation with monoaxial or polyaxial pedicle screws is utilized for stabilization. Monoaxial Schanz screws from the USS Fracture System (DePuy Synthes) are inserted through a midline incision in an open fashion, guided by intraoperative navigation. These screws are placed in the pedicles above and below the fractured vertebra, allowing for compression/distraction maneuvers to reduce fragment retropulsion via ligamentotaxis. After maximizing the effect of indirect distraction, the SpineJack device is inserted under navigation for direct reduction. Alternatively, if percutaneous polyaxial screws are used, 4 small horizontal incisions are required, one for each screw. Once the screws are positioned, compression/distraction maneuvers are used, and the cranial screws’ incisions can be used for SpineJack insertion without the need for additional incisions.

Informed Consent

The necessary informed consent was obtained in this study.

Discussion

Observations

The management of lumbar burst fractures in neurologically intact patients remains a topic of ongoing debate in the field of spine surgery, reflecting a true state of equipoise between surgical and conservative management options.12 Surgical intervention aims to restore spinal stability, decompress neural elements, correct deformities, and expedite recovery; however, it carries risks of postoperative complications.13 Conversely, conservative management avoids surgical risks but often results in prolonged recovery periods and bed rest. The term “burst fractures” encompasses a broad range of pathological alterations in spinal biomechanics, with type A4 fractures representing the most severe subset and typically requiring distinct management strategies.4 Recent survey data indicated that surgical intervention is favored by spine trauma experts in approximately 70% of type A4 fractures, compared with 30% for type A3 fractures, particularly in cases involving severe comminution or potential compromise of the posterior ligamentous complex.7,14

Historically, posterior pedicle screw fixation has been the primary surgical choice for stabilizing lumbar burst fractures. However, this approach is associated with extensive soft tissue dissection, which can lead to muscle degeneration, increased blood loss, extended hospital stays, and longer recovery periods.8,15,16 Additionally, indirect fracture reduction techniques might be insufficient for restoring VBH and reducing posterior wall retropulsion, especially in cases with severe vertebral body comminution. The failure to restore the anterior column can ultimately result in the loss of correction and construct failure at follow-up.9,17,18 Although corpectomy can address some of these limitations, it is a highly invasive procedure associated with significant morbidity, limiting its use to cases involving severe deformities.17,19,20 Additionally, posterior fixation immobilizes the segments above and below the fracture, leading to increased intradiscal pressures and accelerated disc degeneration. Removal of posterior instrumentation after fracture healing requires further surgery, exacerbating soft tissue damage and muscle degeneration.

In recent years, the SpineJack device has emerged as a promising alternative. Initially designed for treating osteoporotic fractures, it has been increasingly used in spinal trauma management and has become a recognized option for type A3 fractures, with growing evidence supporting its use in type A4 fractures.21–25 The device combines PMMA cement augmentation for stabilization and pain relief with direct intrasomatic reduction to counteract the compressive forces of the fracture and restore vertebral height through a minimally invasive posterior approach.26,27 Its craniocaudal expansion mechanism exploits ligamentotaxis and annulotaxis phenomena, allowing fragment repositioning, improving spinal canal patency, and reducing fragment dispersion.26–29 This anatomical restoration allows the injured vertebra to resume near-normal load-bearing function, essential for maintaining the physiological biomechanics of bipedal gait. Additionally, the device’s capability to realign endplates can promote disc healing, enhance pressurization, and improve nutrition, potentially mitigating the risk of accelerated disc degeneration over time.28–30

The SpineJack device is versatile, serving both as a stand-alone treatment and as an adjunct to posterior fixation in complex cases.31,32 Studies by Lofrese et al.24 and Giordan et al.33 have demonstrated that stand-alone use of the SpineJack device reduces surgical invasiveness and blood loss compared with posterior fixation, while still effectively reducing posterior wall retropulsion, restoring VBH, and correcting kyphotic angles with minimal loss of correction at follow-up. Unlike posterior fixation, the SpineJack device does not immobilize adjacent segments, and it does not require hardware removal after fracture healing.24,33 The device is specifically designed to restore anterior column stability directly through a percutaneous approach.

In our study, the SpineJack device was used as a stand-alone treatment for the patients in cases 1 and 2. Notably, the dual implantation in two type A4 fractures in case 2 represents the first report of this kind. Both patients experienced significant pain relief and regained ambulatory function shortly after surgery, with complete pain resolution at follow-up. The patient in case 1 showed a significant gain in RLA with minimal loss over time, an increase in the AP canal diameter, and improved VBH, in line with previous studies. In case 2, while there was effective reduction of posterior wall retropulsion at L4, RLA at L4 decreased in the immediate postoperative period, with a subsequent gain in lordosis at follow-up. Interestingly, Lofrese et al.24 reported a higher rate of correction loss in cases with type S cement leakages, as classified by Yeom et al.34 The patient in case 2, who experienced significant RLA loss, had intraoperative leakage that could be classified as type S (Fig. 4C), which, although asymptomatic, could have contributed to the initial correction loss. Additionally, the L4 RLA measurement included the fractured inferior endplate of L5, which could have impacted the outcome. Postoperative VBH remained stable compared with preoperative values, with minimal intraoperative height gain, likely due to moderate fracture comminution and minimal preoperative height loss. In this case, the primary surgical goal was not to restore VBH, given its preservation, but to achieve spinal stability and increase canal patency while avoiding an extensive posterior construct.

When combined with posterior fixation, the SpineJack device provides circumferential stabilization, reinforcing construct stability, allowing for shorter fixation constructs with improved load distribution, and eliminating the need for corpectomy or long pedicle screw constructs. This combined approach mitigates correction loss and posterior instrumentation failure risk at follow-up and can be performed via a minimally invasive posterior route.33,35,36 Initial biomechanical studies have supported these benefits, and clinical studies by Korovessis et al. and Verlaan et al., focused on balloon kyphoplasty combined with posterior instrumentation, have confirmed these advantages.18,28,35–37 However, balloon kyphoplasty is associated with significant cement leakage rates and intraoperative correction loss due to balloon deflation. The SpineJack device, with its gear-driven mechanism, has replaced balloon kyphoplasty, significantly lowering cement leakage rates and eliminating intraoperative correction loss.18,37 Studies have indicated that combined posterior fixation and SpineJack implantation result in noninferior clinical outcomes and superior radiological outcomes compared with posterior fixation alone in terms of correction loss at follow-up.25,33,38

In our series, the decision to supplement the SpineJack device with pedicle screws was driven by 2 factors: a high degree of vertebral body comminution, assessed using the load-sharing classification, and posterior wall retropulsion occupying more than 50% of the axial section of the spinal canal.39 The rationale behind this decision lies in the unique design of the SpineJack device, which features craniocaudal expansion with a minimal footprint. The SpineJack device, with its thin carjack-like structure, is narrower than other augmentation devices like vertebral body stenting (DePuy Synthes).31 When used to apply intrasomatic distraction forces in a highly comminuted vertebral body, it primarily affects the fragments directly above and below it, providing axial load support. However, this design limits its ability to uniformly correct the entire vertebral body in the case of extensive fragmentation, as central fragments not directly adjacent to the SpineJack device are not adequately pushed toward the adjacent discs. Consequently, the effect on ligamentotaxis is also diminished, with less effective distraction of the anterior and posterior longitudinal ligaments due to incomplete vertebral body correction. To address these limitations, we found that supplementing the SpineJack device with pedicle screws enhanced our outcomes. This combined approach allowed for both indirect and direct ligamentotaxis, allowing for better correction of posterior wall retropulsion and improving load sharing by partially offloading the axial load from the SpineJack device. This reduced the risk of vertebral body overload and correction loss, promoting healing in highly fragmented vertebral bodies. This strategy was used in cases 3 and 4. Clinically, both patients achieved early mobilization and gradual pain resolution, while radiological assessments demonstrated significant vertebral body reconstruction and marked correction of RKAs. These improvements were maintained over time, with only minimal loss of correction observed at follow-up, consistent with outcomes reported in previous studies.33

The primary limitation of our study is the short follow-up duration. Since we are treating younger patients, it is essential to consider the long-term effects of PMMA cement on both biological and biomechanical integration within the vertebral body. While PMMA provides immediate stability by fusing bone fragments with bilateral implants, it has several drawbacks, including the risk of cement leakage and poor integration due to the exothermic reaction during polymerization, which results in the formation of a fibrous barrier around the cement. Calcium phosphate cement, although more brittle, offers isothermic properties that can improve biocompatibility and osteoconductivity, potentially favoring bone deposition around the device in younger patients. However, the combination of calcium phosphate with the SpineJack device has not yet been studied. Furthermore, the stand-alone variant of this technique should be reserved for cases in which the posterior elements are intact, as its effect is limited to restoring the integrity of the anterior column. Another limitation of our study is the use of CT scans for measuring regional kyphosis and lordosis angles. Since CT imaging is performed with the patient in a supine, unloaded position, the measured angles and heights can be altered. Although standing radiographs are preferable for assessing regional angles, they lack the accuracy of CT scans when evaluating VBH and AP canal diameter.

Lessons

The SpineJack device demonstrates considerable potential for managing type A4 lumbar burst fractures in neurologically intact patients. It provides a less invasive alternative to traditional pedicle screw constructs, as well as a valuable adjunct when needed. Its craniocaudal expansion mechanism allows for anatomical restoration of the vertebral body, promoting recovery of its physiological load-bearing function and potentially preserving adjacent disc health. The device can be used either as a stand-alone treatment or alongside posterior fixation, reducing surgical invasiveness. When combined with posterior fixation, it enhances stability and load sharing, especially in cases with high vertebral body comminution. Unlike traditional posterior fixation, the SpineJack device avoids immobilizing adjacent segments, which can reduce drawbacks such as increased intradiscal pressure and the need for hardware removal. However, potential issues like intraoperative cement leakage and the long-term effects of PMMA cement, particularly in younger patients, need further investigation. Exploring alternative cements such as calcium phosphate can help address these concerns. Overall, the SpineJack device represents a promising, less invasive, and more targeted approach to managing lumbar burst fractures.

Disclosures

G-technology paid the open access fee for this article.

Author Contributions

Conception and design: Cracchiolo, Costi, Fanti. Acquisition of data: Cracchiolo, Ticca, Costi, Rampini. Analysis and interpretation of data: Cracchiolo, Costi. Drafting the article: Cracchiolo, Raccagni, Costi. Critically revising the article: Cracchiolo, Raccagni, Rampini, Lanterna, Fanti. Reviewed submitted version of manuscript: Cracchiolo, Fanti. Approved the final version of the manuscript on behalf of all authors: Cracchiolo. Statistical analysis: Cracchiolo, Lanterna. Administrative/technical/material support: Cracchiolo, Rampini. Study supervision: Cracchiolo, Lanterna, Fanti.

Correspondence

Giorgio Cracchiolo: School of Medicine and Surgery, University of Milano-Bicocca, Bergamo, Italy. giocracc99@gmail.com

References

  • 1.Wood KB Li W Lebl DR Ploumis A.. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145-164. [DOI] [PubMed] [Google Scholar]
  • 2.Gertzbein SD. Scoliosis Research Society.. Multicenter spine fracture study. Spine (Phila Pa 1976). 1992;17(5):528-540. [DOI] [PubMed] [Google Scholar]
  • 3.Magerl F Aebi M Gertzbein SD Harms J Nazarian S.. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3(4):184-201. [DOI] [PubMed] [Google Scholar]
  • 4.Vaccaro AR, Oner C, Kepler CK.AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013;38(23):2028-2037. [DOI] [PubMed] [Google Scholar]
  • 5.Tanasansomboon T Kittipibul T Limthongkul W Yingsakmongkol W Kotheeranurak V Singhatanadgige W.. Thoracolumbar burst fracture without neurological deficit: review of controversies and current evidence of treatment. World Neurosurg. 2022;162:29-35. [DOI] [PubMed] [Google Scholar]
  • 6.Vilà-Canet G García de Frutos A Covaro A Ubierna MT Caceres E.. Thoracolumbar fractures without neurological impairment: a review of diagnosis and treatment. EFORT Open Rev. 2016;1(9):332-338. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Aly MM, Dandurand C, Dvorak MF.The influence of comminution and posterior ligamentous complex integrity on treatment decision making in thoracolumbar burst fractures without neurologic deficit? Glob Spine J. 2024;14(1 suppl):41S-48S. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Defino HLA Costa HRT Nunes AA Nogueira Barbosa M Romero V.. Open versus minimally invasive percutaneous surgery for surgical treatment of thoracolumbar spine fractures- a multicenter randomized controlled trial: study protocol. BMC Musculoskelet Disord. 2019;20(1):397. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Hashimura T Onishi E Ota S Tsukamoto Y Yamashita S Yasuda T.. Correction loss following short-segment posterior fixation for traumatic thoracolumbar burst fractures related to endplate and intervertebral disc destruction. BMC Musculoskelet Disord. 2023;24(1):174. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Smith ZA Fessler RG.. Paradigm changes in spine surgery: evolution of minimally invasive techniques. Nat Rev Neurol. 2012;8(8):443-450. [DOI] [PubMed] [Google Scholar]
  • 11.Noriega D, Krüger A, Ardura F.Clinical outcome after the use of a new craniocaudal expandable implant for vertebral compression fracture treatment: one year results from a prospective multicentric study. Biomed Res Int. 2015;2015:927813. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Dvorak MF Öner CF Schnake K Dandurand C Muijs S.. From radiographic evaluation to treatment decisions in neurologically intact patients with thoraco-lumbar burst fractures. Glob Spine J. 2024;14(1 suppl):4S-7S. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Bradford DS McBride GG.. Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits. Clin Orthop Relat Res. 1987;(218):201-216. [PubMed] [Google Scholar]
  • 14.Camino-Willhuber G, Bigdon S, Dandurand C.Expert opinion, real-world classification, and decision-making in thoracolumbar burst fractures without neurologic deficits? Glob Spine J. 2024;14(1 suppl):49S-55S. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Sun XY Zhang XN Hai Y.. Percutaneous versus traditional and paraspinal posterior open approaches for treatment of thoracolumbar fractures without neurologic deficit: a meta-analysis. Eur Spine J. 2017;26(5):1418-1431. [DOI] [PubMed] [Google Scholar]
  • 16.Gong Y Fu G Li B Li Y Yang X.. Comparison of the effects of minimally invasive percutaneous pedicle screws osteosynthesis and open surgery on repairing the pain, inflammation and recovery of thoracolumbar vertebra fracture. Exp Ther Med. 2017;14(5):4091-4096. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Korovessis P Baikousis A Zacharatos S Petsinis G Koureas G Iliopoulos P.. Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures. Spine. 2006;31(8):859-868. [DOI] [PubMed] [Google Scholar]
  • 18.Korovessis P Repantis T Petsinis G Iliopoulos P Hadjipavlou A.. Direct reduction of thoracolumbar burst fractures by means of balloon kyphoplasty with calcium phosphate and stabilization with pedicle-screw instrumentation and fusion. Spine. 2008;33(4):E100-E108. [DOI] [PubMed] [Google Scholar]
  • 19.Wipplinger C, Lener S, Orban C.Technical nuances and approach-related morbidity of anterolateral and posterolateral lumbar corpectomy approaches—a systematic review of the literature. Acta Neurochir (Wien). 2022;164(8):2243-2256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Knop C Kranabetter T Reinhold M Blauth M.. Combined posterior-anterior stabilisation of thoracolumbar injuries utilising a vertebral body replacing implant. Eur Spine J. 2009;18(7):949-963. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Noriega D, Maestretti G, Renaud C.Clinical performance and safety of 108 SpineJack implantations: 1-year results of a prospective multicentre single-arm registry study. Biomed Res Int. 2015;2015:173872. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Noriega DC, Crespo-Sanjuan J, Olan WJ.Treatment of thoracolumbar Type A3 fractures using a percutaneous intravertebral expandable titanium implant: long-term follow-up results of a pilot Single Center study. Pain Physician. 2021;24(5):E631-E638. [PubMed] [Google Scholar]
  • 23.Ould-Slimane M, Petit A, Gille O.A prospective multicenter randomized study comparing the SpineJack system and nonsurgical management with a brace in acute traumatic vertebral fractures: the SPICO study. J Neurosurg Spine. 2024;40(6):790-800. [DOI] [PubMed] [Google Scholar]
  • 24.Lofrese G, Ricciardi L, De Bonis P.Use of the SpineJack direct reduction for treating type A2, A3 and A4 fractures of the thoracolumbar spine: a retrospective case series. J Neurointerv Surg. 2022;14(9):931-937. [DOI] [PubMed] [Google Scholar]
  • 25.Kerschbaumer G Gaulin B Ruatti S Tonetti J Boudissa M.. Clinical and radiological outcomes in thoracolumbar fractures using the SpineJack device. A prospective study of seventy-four patients with a two point three year mean of follow-up. Int Orthop. 2019;43(12):2773-2779. [DOI] [PubMed] [Google Scholar]
  • 26.Venier A, Roccatagliata L, Isalberti M.Armed kyphoplasty: an indirect central canal decompression technique in burst fractures. AJNR Am J Neuroradiol. 2019;40(11):1965-1972. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Muto M Marcia S Guarnieri G Pereira V.. Assisted techniques for vertebral cementoplasty: why should we do it? Eur J Radiol. 2015;84(5):783-788. [DOI] [PubMed] [Google Scholar]
  • 28.Verlaan JJ van de Kraats EB Oner FC van Walsum T Niessen WJ Dhert WJA.. The reduction of endplate fractures during balloon vertebroplasty: a detailed radiological analysis of the treatment of burst fractures using pedicle screws, balloon vertebroplasty, and calcium phosphate cement. Spine. 2005;30(16):1840-1845. [DOI] [PubMed] [Google Scholar]
  • 29.Krüger A, Oberkircher L, Figiel J.Height restoration of osteoporotic vertebral compression fractures using different intravertebral reduction devices: a cadaveric study. Spine J. 2015;15(5):1092-1098. [DOI] [PubMed] [Google Scholar]
  • 30.Baeesa SS Krueger A Aragón FA Noriega DC.. The efficacy of a percutaneous expandable titanium device in anatomical reduction of vertebral compression fractures of the thoracolumbar spine. Saudi Med J. 2015;36(1):52-60. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Moura DL Gabriel JP.. Expandable intravertebral implants: a narrative review on the concept, biomechanics, and outcomes in traumatology. Cureus. 2021;13(9):e17795. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Moura DL.. The role of kyphoplasty and expandable intravertebral implants in the acute treatment of traumatic thoracolumbar vertebral compression fractures: a systematic review. EFORT Open Rev. 2024;9(4):309-322. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Giordan E, Del Verme J, Pastorello G.Treatment of thoracolumbar burst fractures: SpineJack vs. posterior arthrodesis-comparison of clinical and radiological outcomes. J Spine Surg. 2022;8(2):242-253. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Yeom JS Kim WJ Choy WS Lee CK Chang BS Kang JW.. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg Br. 2003;85(1):83-89. [DOI] [PubMed] [Google Scholar]
  • 35.Krüger A Schmuck M Noriega DC Ruchholtz S Baroud G Oberkircher L.. Percutaneous dorsal instrumentation of vertebral burst fractures: value of additional percutaneous intravertebral reposition-cadaver study. Biomed Res Int. 2015;2015:434873. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Mermelstein LE McLain RF Yerby SA.. Reinforcement of thoracolumbar burst fractures with calcium phosphate cement. A biomechanical study. Spine (Phila Pa 1976). 1998;23(6):664-671. [DOI] [PubMed] [Google Scholar]
  • 37.Verlaan JJ Dhert WJA Verbout AJ Oner FC.. Balloon vertebroplasty in combination with pedicle screw instrumentation: a novel technique to treat thoracic and lumbar burst fractures. Spine (Phila Pa 1976). 2005;30(3):E73-E79. [DOI] [PubMed] [Google Scholar]
  • 38.Finoco M, Dejean C, Giber D.Sagittal correction after short percutaneous fixation for thoracolumbar compression fractures: comparison of the combination of SpineJack® kyphoplasty and fractured vertebra screw fixation. Int Orthop. 2023;47(5):1295-1302. [DOI] [PubMed] [Google Scholar]
  • 39.McCormack T Karaikovic E Gaines RW.. The load sharing classification of spine fractures. Spine (Phila Pa 1976). 1994;19(15):1741-1744. [DOI] [PubMed] [Google Scholar]

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