Trans-fracture approach of intra-body supporter implantation for thoracolumbar vertebral compression fractures: A technical note and 18 cases with 2-year follow-up

PURPOSE: Vertebral body height loss happens after restoration due to insufficient support. This note described a novel technique for the restoration of vertebral compression fracture (VCF). The feasibility and safety of the proposed surgical technique were proved. METHODS: This is a prospective study including patients from May 2022 to May 2023. Non-osteoporotic VCF patients were treated with trans-fracture intra-vertebral body fusion (TFIF) surgery. Patients who met the following criteria were included: (1) age < 55 years; (2) single-level VCF with or without neurologic symptoms; (3) reduced anterior vertebral body height > 20% measured from lateral X-ray radiography; (4) A1 and A3 VCF of AO type; (5) written informed consent. Cases with fractures caused by infection and tumor, and a history of inter-body fusion procedure were excluded, as well as patients with a follow-up period of less than 1 year. The anterior vertebral height proportion (AVBH), median vertebral height proportion (MVBH), posterior vertebral height proportion (PVBH), Cobb angle, wedge angle, and visual analogue scale (VAS) were measured at any follow-up time point. Differences between pre- and post-operation, and post-operation and final follow-up time points were compared through a paired Wilcoxon test (non-normal distribution data) or a paired t-test (normal distribution data). RESULTS: A total of 18 patients, aged (47.9 ± 7.8) years, were finally included in the study with an average follow-up period of (24.8 ± 5.4) months. The TFIF surgery restored AVBH, MVBH, and PVBH from 0.594 ± 0.090 to 0.927 ± 0.052, 0.626 ± 0.114 to 0.910 ± 0.077, and 0.899 ± 0.067 to 0.970 ± 0.034, respectively (all p < 0.001). Meanwhile, the AVBH, MVBH, and PVBH were maintained well from immediate post-operation to final follow-up: 0.927 ± 0.052 vs. 0.927 ± 0.039, 0.910 ± 0.077 vs. 0.921 ± 0.047, and 0.970 ± 0.034 vs. 0.978 ± 0.031, respectively. Cobb angle and wedge angle lost slightly from immediate post-operation to final follow-up: 4.21° ± 4.02° vs. 6.41° ± 3.83°, and 5.49° ± 9.61° vs. 7.99° ± 12.51°, respectively. The TFIF surgery relieved pain efficiently (7.94 ± 0.54 vs. 4.89 ± 0.58, p < 0.001). CONCLUSION: The TFIF surgery restored the vertebral height almost completely. The cage supported and maintained vertebral height in the long-term with a slight loss. Thus, the TFIF surgery is a safe and feasible approach.