Minimally invasive approach and posterior instrumental arthrodesis in earthquake-related vertebral fractures

Background: On the morning of 06 February 2023, a devastating earthquake of magnitude 7.8 occurred, affecting the south and east of Turkey and the north and west of Syria. High-energy traumas, like earthquakes can cause vertebral burst fractures. In surgical treatment, arthrodesis with pedicle screw-rods or minimally invasive percutaneous systems are often applied depending on the patient’s condition. A comparative analysis was conducted to evaluate the efficacy and outcomes of surgical interventions for thoracolumbar vertebra fractures caused by seismic events. The techniques examined included classical pedicle screws and rods, as well as minimally invasive percutaneous cementoplasty. Methods: The study included 42 patients who had undergone surgery at the Neurosurgery Clinic of Kayseri City Hospital, Kayseri, Turkey, with a diagnosis of burst fracture subsequent to the earthquake. The surgical approach employed was either classical open surgery with the use of screws and rods or minimally invasive vertebral cementoplasty. Results: In this retrospective study, comprising 23 females (54.8%) and 19 males. A minimally invasive procedure was performed in 25 patients (59.5%), an instrumental procedure in 15 patients (35.7%), and a combination of both in 2 patients (4.8%). Patients who underwent instrumental surgery were younger, while patients who underwent minimally invasive surgery were older (p < 0.05). Conclusions: In vertebral fractures caused by earthquakes, the results obtained with pedicle screwing and minimally invasive methods were consistent with those reported in the literature. Minimally invasive treatment was also frequently preferred and had good results similar to open surgery and faster recovery times.

Spinal fractures; Cementoplasty; Minimally invasive surgical procedures; Natural disasters

[1] Bensch FV, Kiuru MJ, Koivikko MP, Koskinen SK. Spine fractures in falling accidents: analysis of multidetector CT findings. European Radiology. 2004; 14: 618–624.

[2] Reinhold M, Knop C, Beisse R, Audigé L, Kandziora F, Pizanis A, et al. Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. European Spine Journal. 2010; 19: 1657–1676.

[3] Azam Q, Sadat-Ali M. The concept of evolution of thoracolumbar fracture classifications helps in surgical decisions. Asian Spine Journal. 2015; 9: 984–994.

[4] Weinstein JN, Collalto P, Lehmann T. Thoracolumbar “burst” fractures treated conservatively: a long-term follow-up. Spine. 1988; 13: 33–38.

[5] Andress HJ, Braun H, Helmberger T, Schürmann M, Hertlein H, Hartl WH. Long-term results after posterior fixation of thoraco-lumbar burst fractures. Injury. 2002; 33: 357–365.

[6] Knop C, Blauth M, Bastian L, Lange U, Kesting J, Tscherne H. Fractures of the thoracolumbar spine. Late results of dorsal instrumentation and its consequences. Unfallchirurg. 1997; 100: 630–639. (In German)

[7] Ulu MO, Akgun MY, Alizada O, Akcil EF, Kartum T, Hanci M. Posterior-only approach in patients with poor general condition and spinal metastatic vertebral fracture. Neurocirugía. 2023; 34: 247–255.

[8] Garnier L, Tonetti J, Bodin A, Vouaillat H, Merloz P, Assaker R, et al. Kyphoplasty versus vertebroplasty in osteoporotic thoracolumbar spine fractures. Short-term retrospective review of a multicentre cohort of 127 consecutive patients. Orthopaedics & Traumatology: Surgery & Research. 2012; 98: S112–S119.

[9] Özdemir G, Karlıdağ T, Bingöl O, Sarıkaya B, Çağlar C, Bozkurt İ, et al. Systematic triage and treatment of earthquake victims: our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake. Joint Diseases and Related Surgery. 2023; 34: 480–487.

[10] Cakir IM, Sengul I, Bekci T, Tonkaz G, Eryuruk U, Onder RO, et al. A needful, unique, and in-place evaluation of the injuries in earthquake victims with computed tomography, in catastrophic disasters! The 2023 Turkey-Syria earthquakes: part I. Revista da Associacao Medica Brasileira. 2023; 69: e20230399.

[11] Tonkaz G, Şengül D, Bekçi T, Şengül İ, Çakır İM, Önder RO, et al. A needful, unique, and in-place evaluation of the injuries in earthquake victims with computed tomography, in catastrophic disasters! The 2023 Turkey-Syria earthquakes: part II. Revista da Associacao Medica Brasileira. 2023; 69: e20230550.

[12] Sui P, Yu T, Sun S, Chao B, Qin C, Wang J, et al. Advances in materials used for minimally invasive treatment of vertebral compression fractures. Frontiers in Bioengineering and Biotechnology. 2023; 11: 1303678.

[13] Aduri TT, Dhillon M, Bansal P, Vatkar A, Dhatt SS, Kumar V. Comprehensive systematic-review and meta-analysis: treatment outcomes of unipedicular vs bipedicular approaches in vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures. Journal of Clinical Orthopaedics and Trauma. 2025; 66: 103010.

[14] Chandra RV, Maingard J, Asadi H, Slater LA, Mazwi TL, Marcia S, et al. Vertebroplasty and kyphoplasty for osteoporotic vertebral fractures: what are the latest data? American Journal of Neuroradiology. 2018; 39: 798–806.

[15] Joyce DM, Granville M, Berti A, Jacobson RE. Vertebral augmentation compared to conservative treatment of vertebra plana and high degree osteoporotic vertebral fractures: a review of 110 fractures in 100 patients. Cureus. 2022; 14: e22006.

[16] Adrian SN, Tarek OP, Jan-Dirk C, Mommsen P, Graulich T, Stublig T. Profit analysis of minimal-invasive approaches for surgical treatment of A3 spinal burst fractures. In Vivo. 2022; 36: 2999–3009.

[17] Wen Z, Mo X, Zhao S, Lin W, Chen Z, Huang Z, et al. Comparison of percutaneous kyphoplasty and pedicle screw fixation for treatment of thoracolumbar severe osteoporotic vertebral compression fracture with kyphosis. World Neurosurgery. 2021; 152: e589–e596.

[18] Tang Y, Li H, Ruan X, Yan H, Sun J, Chen K. Percutaneous kyphoplasty with or without posterior pedicle screw fixation for the management of severe osteoporotic vertebral compression fractures with non-union. Journal of Orthopaedic Surgery and Research. 2024; 19: 240.

[19] Boss S, Srivastava V, Anitescu M. Vertebroplasty and kyphoplasty. Physical Medicine and Rehabilitation Clinics of North America. 2022; 33: 425–453.

[20] 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 Reviews. 2024; 9: 309–322.

[21] Verlaan JJ, Dhert WJ, Verbout AJ. Balloon vertebroplasty in combination with pedicle screw instrumentation a novel technique to treat thoracic and lumbar burst fractures. Spine. 2005; 30: E73–E79.

[22] Sheng W, Jiang H, Hong C, Hu H, Yuan H, Gu X, et al. Comparison of outcome between percutaneous pedicle screw fixation and the mini-open Wiltse approach with pedicle screw fixation for neurologically intact thoracolumbar fractures: a retrospective study. Journal of Orthopaedic Science. 2022; 27: 594–599.

[23] Kocis J, Kelbl M, Kocis T, Návrat T. Percutaneous versus open pedicle screw fixation for treatment of type A thoracolumbar fractures. European Journal of Trauma and Emergency Surgery. 2020; 46: 147–152.