Modified posterior spinal decompression via vertebral wedge resection for severe thoracolumbar burst fractures with neurological deficits

Surgical treatment of thoracolumbar burst fractures (TLBFs) presenting with severe traumatic stenosis and neurological deficits resulting from fragment retropulsion continues to be debated, as current approaches carry notable limitations. We proposed a posterior vertebral wedge resection (pVWR) via unilateral transpedicular for decompression and evaluated its radiological and clinical outcomes. We retrospectively analyzed 15 TLBFs patients (mean age 39.4 years, range from 25 to 58 years; mean follow-up 27.6 months, range from 9 to 48 months ) with severe spinal canal stenosis (≥ 66% encroachment by retropulsed fragments) or compromised by reverse cortical fragments treated by pVWR. Preoperative and final follow-up radiological parameters, neurological function, clinical outcomes, and complications were assessed. Mean estimated blood loss was 593.3 ± 293.9 mL and the operating time was 258.1 ± 67.0 min. Overall, the mean traumatic spinal stenosis rate (tSSR, defined as the proportion of the spinal canal cross-sectional area occupied by retropulsed vertebral bone fragments) improved from 60.9% preoperatively to 0.7% postoperatively, and tSSR was reduced from 74.5% to 0 for patients with severe spinal canal stenosis. From preoperatively to the final follow-up, Cobb angle changed from 5.8° to − 8.4°, and vertebral body compression ratio decreased from 60.5% to 8.3%. Twelve patients with incomplete neurologic deficits achieved ASIA grade improvement. VAS score decreased from 8.3 to 1.3, and ODI from 84.3% to 16.8%. Postoperative cerebrospinal fluid leakage occured in 3 patients. No implant failure occurred. Although anterior vertebrectomy and fusion is generally recommended for TLBFs with severe spinal canal encroachment or inverted retropulsed fragments, satisfactory decompression and neurological recovery can also be achieved by this pVWR technique in such patients.