Abstract
BACKGROUND: Type A4 lumbar burst fractures are severe spinal injuries typically treated with posterior pedicle screw constructs, with or without corpectomy. However, traditional approaches can be highly invasive and are often limited in their ability to reconstruct the anterior column. The SpineJack device offers a minimally invasive alternative or complement to posterior fixation. OBSERVATIONS: Four neurologically intact patients with lumbar type A4 fractures were treated using the SpineJack device, either alone or in combination with different posterior fixation techniques. Clinical and radiological outcomes were evaluated preoperatively, postoperatively, and at the 1-year follow-up. The procedure led to significant pain relief and rapid mobilization for all patients. Radiologically, it restored vertebral body height (VBH), increased spinal canal patency, and corrected preoperative deformities, with minimal loss of correction at follow-up. LESSONS: The SpineJack device is a viable, less invasive alternative to traditional pedicle screw constructs and serves as an effective adjunct for stabilization, potentially replacing corpectomy in some cases. It restores VBH and alignment, maintains load-bearing capacity, and reduces the need for additional hardware. Further research is needed to evaluate long-term outcomes, especially in younger patients. https://thejns.org/doi/10.3171/CASE24821.