Extrapedicular approach of percutaneous vertebroplasty in the treatment of upper and mid‐thoracic vertebral compression fracture

Abstract

S. Extrapedicular approach of percutaneous vertebroplasty in the treatment of upper and mid-thoracic vertebral compression fracture. Acta Radiol 2005;46:280-287.Purpose: To evaluate the clinical outcome of the extrapedicular approach of percutaneous vertebroplasty (PVP) for upper and mid-thoracic vertebral compression fractures in patients. Material and Methods: Extrapedicular vertebroplasty was performed in painful compression fractures at T4-T8 levels. The assessment criteria were changes over time in visual analog scale (VAS) and mobility score. We evaluated the volume of cement injected, the size of needle required, and complications. Results: Procedures were performed in 27 patients with a total of 34 affected vertebral bodies. Early (within a week) and one year later, clinical follow-ups showed that pain intensity had decreased by 50% one day after operation and later by 70-80%. Mobility scores of all patients were improved immediately after the procedure. Average volume of polymethylmethacrylate (PMMA) per vertebral body was 3.8¡1.2 ml. Leakage of PMMA occurred in one vertebral level (intradiskal space), but did not cause clinical complications. Conclusion: PVP of upper and mid-thoracic spine with an extrapedicular approach is an efficient and safe procedure for treating painful thoracic vertebral compression fracture under a cautious patient selection and meticulous technical procedure.

An anatomical study of transpedicular vs. extrapedicular approach for kyphoplasty and vertebroplasty in the thoracic spine

“…The close proximity of the transpedicular approach to the spinal cord suggests a higher risk of spinal cord injury compared to the extrapedicular approach. Specific complications in the extrapedicular approach are rib fractures, pleural tears, pneumothorax or paraspinous haematoma [13] . For kyphoplasty, the standard bilateral transpedicular cannulation is described from T10 to L5 and for vertebroplasty from T5 or T6 to L5 [10] .…”

Unilateral Percutaneous Vertebroplasty For Osteoporotic Lumbar Compression Fractures: A Comparative Study Between Transverse Process Root-Pedicle Approach And Conventional Transpedicular Approach

“…Therefore, some scholars have used the extrapedicular approach and TPRPA in clinical practice, but extrapedicular approach is mainly used in cases with mid-thoracic vertebra or thin pedicle due to the risk of vascular injury [14][15][16][17][18] . Yan L, et, al. reported TPRPA is a relatively safe and effective approach with less radiation dosage and shorter surgical time [19,20] .…”

Controversies on Vertebroplasty and Kyphoplasty for Vertebral Compression Fractures

“…35 These patients should be operated under neuromonitoring or local anesthesia with an anterior delivery of cement, similarly to those with upper thoracic or cervical spine fractures. 39 Recently, Sun et al 40 reviewed the results of vertebroplasty for painful spinal metastasis in 43 patients with epidural encroachment in whom open surgery was not available due to poor general medical status and limited life expectancy. In this series, 32% presented signs of cord or cauda equina compression preoperatively.…”

“…53 Also, a unilateral extra-pedicular approach has been described in the literature with good results. 39 The unilateral transpedicular approach has been proposed in order to reduce operative time, costs, radiation exposure and risk of medial pedicular violations. 54 Another theoretical benefit of the unilateral approach is that it reduces the possibility of cement leakage through the canula tract, which could cause nerve injury.…”