“AO-K” Treating Plana, Pincer, Burst, and Pathologic Fractures with Implantable Devices.

Monday, March 31, 2025

5:10 PM – 5:15 PM CT

Location: Music City Center, 207 AB

Abstract Presenter(s)

RA

Rohit Anand, MD

Diagnostic Radiology Resident Physician
Loyola University Medical Center, United States

Author/Co-author(s)

DH

Daniel Heller, MD

Resident Physician
Loyola University Medical Center, United States
RE

Rami El-Baba, MD

Resident
Loyola University Medical Center, United States
AM

Angelo Malamis, MD

Interventional Radiologist
Loyola University Medical Center, United States

Learning Objectives: 1) Describe imaging features of vertebral body fracture patterns (AO Classification system) that are amenable to IR guided augmentation. 2) Provide an overview of implantable devices for the management of complex vertebral fractures as well as indications for use. 3) Emphasize how the utilization of intra-procedural cone-beam CT (CBCT) can improve technical proficiency and safety in the management of complex vertebral fractures including vertebra plana, pincer/split, burst, and pathologic fractures.

Background: Vertebral compression fractures (VCF) are associated with high rates of morbidity and mortality. VCF may be secondary to trauma, osteoporosis, or pathologic fracture, and result in complex fracture patterns that are especially challenging to treat. The AO classification system defines fracture patterns which guides treatment decisions. Traditionally, percutaneous treatments such as vertebroplasty and kyphoplasty have been largely focused on managing A1 or common wedge or compression fractures with more complex fractures posing a greater challenge. Advances in the field, both in terms of available implantable devices as well as intraoperative imaging techniques have aided in improving success rates, especially for complex fractures. The use of mechanical augmentation with implantable devices has allowed for optimal fracture reduction and deposition of cement with less risk of cement extravasation or leak.

Clinical Findings/Procedure Details: We present a series of cases highlighting the management of complex fractures that include pincer or coronal split (A2), burst (A3 and A4), vertebral plana, and pathologic lytic fractures in addition to those exhibiting retropulsion. Severe vertebra plana, complete burst, or comminuted pathological fracture cases are challenging as interposition of Kirshner wires between the end plates may be unclear under fluoroscopy alone. CBCT provides three-dimensional characterization to ensure proper wire placement prior to implementation of an implantable device to satisfactory span and consolidate deformed fracture fragments. We demonstrate our experience utilizing intraprocedural CBCT to expand the patient population managed confidently and safely with mechanical augmentation.

Conclusion and/or Teaching Points:
The utilization of implantable devices for mechanical stabilization has allowed for more satisfactory treatment of the most complex fracture patterns. CBCT can be an effective tool for improved technical proficiency in PVA, altering and enhancing intraprocedural management to achieve durable and optimal results in select cases.