Vertebral Fracture Repair

This chapter focuses on spinous process fracture, implant failure or migration, hemorrhage and spinal compression caused by soft tissues. Fractures of dorsal spinous processes are most commonly associated with spinal plating or spinal stapling. Fractures of transverse processes are rare complications of spinal stapling. Plates should be placed as close to the base of the spinous processes as possible. Overall, spinal process plating and spinal stapling have become historical means of fixation and have been replaced by biomechanically superior techniques. Postoperative compression of the spinal cord after fracture repair may result from the presence of soft tissues, such as soft callous, hematomas, nucleus pulposus, annulus fibers, or hypertrophy of the dorsal annular ligament caused by instability. Decompressive surgery should be considered in cases with deteriorating or unsatisfactory neurologic signs, consistent with the presence of a compressive lesion on advanced imaging.