Spinal Endoscopy-Targeted Bone Grafting for the Vertebral “Shell” Phenomenon: A Case Report

Abstract

In thoracolumbar burst fractures, internal fixation using the distraction reduction screw-rod system via the posterior approach can result in a "shell" in the vertebral body. This "shell" is difficult to detect via intraoperative fluoroscopy and is generally detected during postoperative follow-up imaging. The high incidence of such "shell" is a critical factor resulting in serious complications, including vertebral collapse, nonunion, and internal fixation failure. However, no standardized clinical treatment has been identified for this "shell" phenomenon. Herein, we report the case of a patient who presented with low back pain and discomfort after developing a nonunion owing to the "shell" in the lumbar 3 vertebral body 14 months after internal fixation of a lumbar fracture. The patient underwent spinal endoscopy-targeted bone grafting via superior pedicle notch approach. The patient's low back pain was relieved one month postoperatively and the internal fixation device was removed at 9 months postoperatively after bony healing of a fracture of the lumbar 3 vertebrae. This procedure can effectively support the anterior middle column and promote vertebral fracture healing and is minimally invasive, precise, safe, and effective; therefore, we recommend this novel procedure for the "shell" phenomenon surgery for lumbar vertebral fractures.