Vertebroplasty

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Introduction:
Vertebroplasty is an established surgical method of reinforcing vertebral bodies with compression fractures; either osteoporotic or pathological. The standard trajectory for cannulation is bilateral transpedicular. However, there are other clinical scenarios when this route is not applicable. The extrapedicular approach has been described as an alternative approach for those cases [10]. Except from these procedures in the lumbar spine, the thoracic spine pose special neuroanatomic challenges, considering the relatively small pedicle size and severe angulation from physiological kyphosis in the mid- and upper thoracic spine.
The transdiscal trajectory for stabilization has been reported with the introduction of the transdiscal …show more content…
At T10 we performed a unilateral approach and advanced the Jamshidi needle to the middle of the vertebral body which was symmetrically filled with the PMMA cement. For the T9 level, however, the option of a transpedicular route was not feasible. We proceeded from the contralateral T10 vertebral pedicle through the T9-T10 disc space into the body of the T9 vertebra (Figure 3). The starting point at the skin level was caudal to the T10 pedicle, approximately 1 cm lateral to the lateral border of the pedicle on the AP scan. The pedicle entrance started at the infero-latero-posterior aspect of the pedicle in order to proceed cranially, medially and anteriorly. Specific attention was given to make sure that the tip of the Jamshidi needle was ventral to the spinal canal as it was advanced beyond the medial border of the pedicle. The needle was advanced into the disc space and then to the T9 vertebral body. After filling the anterior and middle portions of T9 we pulled out the Jamshidi needle. There was slight extravasation of PMMA cement into the T9-T10 disc space, presumably through the defect created by the Jamshidi needle in the inferior end plate of T9 (Figure 3).
The patient was discharged home after the surgery. On follow up she didn't show any signs of progressive kyphosis. The patient later had the second stage and the lower part of the hardware, …show more content…
report cases with balloon kyphoplasty using the extrapedicular approach [3,11]. But even if the extrapedicular approach is used, starting far lateral or using Kambin's triangle, it is difficult to manipulate the Jamshidi needle for optimal placement as the pedicle screws interfere with the needle; especially in the mid- and upper thoracic spine. Therefore only the transdiscal cannulation starting from adjacent vertebrae, as described in the presented two cases, provides the necessary angle to avoid the screws in this spine location and bring the Jamshidi needle to the middle of the vertebral body. Only with this here newly described technique one can perform vertebroplasty to the most cranial thoracic vertebra of the fused segment. Using such a transdiscal trajectory it is also possible to perform balloon kyphoplasty. In our cases we used the StabiliT® system which includes an osteotome to create a cavity in the vertebral bone instead of the classic balloon dilatation. Because of the existing pedicle screws we did not use the osteotome. To date, cannulation of the instrumented vertebrae in the middle of construct has not been described in the
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