Percutaneous approach to the upper thoracic spine: optimal patient positioning

Bayley, Edward; Clamp, Jonathan A.; Boszczyk, Bronek M.

doi:10.1007/s00586-009-1075-9

Cited by 10 publications

(11 citation statements)

References 9 publications

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“…Multiple literature sources agree that the risk of cement extravasation in PKP is reduced because the inflated balloon creates a void within the vertebral body, into which cement is injected under low pressure. Vertebral body with cavity facilitates injection under low pressure because cement usually seeks the potential space preferentially. As shown in previous studies, a higher frequency of vascular cement seepage was noted in cases of vertebral body without cavity.…”

Section: Discussionmentioning

confidence: 60%

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Pulmonary Cement Embolism Associated with Percutaneous Vertebroplasty or Kyphoplasty: A Systematic Review

Wang

Yang

Shi

et al. 2012

Orthopaedic Surgery

120

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Therapeutic vertebral cement augmentation for the treatment of painful skeletal diseases, although widely applied for more than several decades, still has not thoroughly resolve the problem of cement extravasation. Based on a review of literature published, the present study was to provide a systematic review of the current understanding of pulmonary cement embolism (PCE) associated with percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP), and to summarize the incidence, clinical features, prophylaxis and therapeutic management of PCE after vertebral cement reinforcement. The reported incidence of PCE ranges widely, from 2.1% to 26%. Asymptomatic PCE is a common condition without permanent clinical sequelae. Nevertheless, it is emergent once a symptomatic PCE is presented. Close attention and effective pre-measures should be taken to avoid this catastrophic complication.

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Section: Discussionmentioning

confidence: 60%

“…Nevertheless, fluoroscopic visualization is usually obscured by shoulders in the lateral projection in the cervical and high thoracic areas. Bayley et al . recently shared a modified but simple position that significantly improves the fluoroscopic lateral imaging of the upper thoracic spine.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Cement Embolism Associated with Percutaneous Vertebroplasty or Kyphoplasty: A Systematic Review

Wang

Yang

Shi

et al. 2012

Orthopaedic Surgery

120

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“…For procedures at T5 and above, the arms were adducted and a longitudinal bolster placed under the sternum to allow the shoulder girdle to drop anteriorly. This significantly reduced superimposition of the scapula on the thoracic spine in the lateral image [6]. All procedures were performed using standard mobile image intensifiers.…”

Section: Methodsmentioning

confidence: 99%

Safety of fluoroscopy guided percutaneous access to the thoracic spine

Clamp¹,

Bayley²,

Ebrahimi³

et al. 2012

Eur Spine J

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“…This is compounded by the difficulty to obtain clear lateral fluoroscope images due to the obstruction caused by the shoulder girdle, which is a very crucial fluoroscopic view during the insertion of the percutaneous screw. Bayley et al 31 had suggested placing the patient in a special prone position with a bolster placed under the sternum allowing the scapula to fall forward avoiding the overlay of the shoulder girdle on the lateral fluoroscopic images. Singh et al 32 had suggested the usage of oblique fluoroscopic images to identify the anatomical spine levels over the distal cervical and proximal thoracic spine.…”

Section: Discussionmentioning

confidence: 99%

The use of fluoroscopic guided percutaneous pedicle screws in the upper thoracic spine (T1–T6): Is it safe?

Kwan

Chiu

Chan

et al. 2017

Journal of Orthopaedic Surgery

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Purpose: This study analysed the accuracy and safety of the fluoroscopic guided percutaneous screws in the upper thoracic vertebrae (T1-T6). Methods: Computed tomography scans from 74 patients were retrospectively evaluated between January 2008 and December 2012. Pedicle perforations were classified by two types of grading systems. For medial, lateral, superior and inferior perforations: grade 0 -no violation; grade 1 -<2 mm; grade 2 -2-4 mm and grade 3 ->4 mm. For anterior perforations: grade 0 -no violation; grade 1 -<4 mm; grade 2 -4-6 mm and grade 3 ->6 mm.Results: There were 35 (47.3%) male and 39 (52.7%) female patients with a total 260 thoracic pedicle screws (T1-T6) analysed. There were 32 screw perforations which account to a perforation rate of 12.3% (11.2% grade 1, 0.7% grade 2 and 0.4% grade 3). None led to pedicle screw-related complications. The perforation rate was highest at T1 (33.3%, all grade 1 perforations), followed by T6 (14.5%) and T4 (14.0%). Conclusion: Fluoroscopic guided percutaneous pedicle screws of the upper thoracic spine (T1-T6) are technically more demanding and carry potential risks of serious complications. Extra precautions need to be taken when fluoroscopic guided percutaneous pedicle screws are placed at T1 and T2 levels, due to high medial pedicular angulation and obstruction of lateral fluoroscopic images by the shoulder girdle and at T4-T6 levels, due to smaller pedicular width.

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Percutaneous approach to the upper thoracic spine: optimal patient positioning

Cited by 10 publications

References 9 publications

Pulmonary Cement Embolism Associated with Percutaneous Vertebroplasty or Kyphoplasty: A Systematic Review

Pulmonary Cement Embolism Associated with Percutaneous Vertebroplasty or Kyphoplasty: A Systematic Review

Safety of fluoroscopy guided percutaneous access to the thoracic spine

The use of fluoroscopic guided percutaneous pedicle screws in the upper thoracic spine (T1–T6): Is it safe?

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