Percutaneous extrapedicular vertebroplasty with expandable intravertebral implant in compression vertebral body fracture in pediatric patient—technical note

Abstract

PurposeThe aim of the article is to present the new extrapedicular percutaneous technique for posttraumatic vertebral column fracture.MethodsA 15-year-old boy needed a surgical Th8 posttraumatic vertebral body (VB) compressive fracture reduction due to insufficient conservative treatment and consistent severe clinical symptoms. After 6 months of external Jevett long-roll brace stabilization, progressive sagittal balance disturbance of thoracic kyphosis was measured and persistent clinical symptoms were observed. It was decided to present a surgical technique method allowing to attempt to reduce VB fracture, rebalance the vertebral column (VC) without any motion limitation, and decrease clinical symptoms. The procedure was performed percutaneously from extrapedicular approach with intravertebral implant (Spine Jack®—Vexim™) and cement (Interface®—Vexim™) under fluoroscopic imaging (Ziehm™ 8000®).ResultsThe whole procedure was uneventful. Now, the child is free from clinical symptoms and the partial reduction of VB fracture was achieved. The patient has been followed for 3 months. In the control CT scans, the VB fracture reduction is stable and no progression of thoracic kyphosis angle is observed. Furthermore since the surgical procedure, the patient is clinical symptom free.ConclusionThe extrapedicular percutaneus technique of VB fracture reduction with intravertebral fixation allowed to partially reduce the VB compressive fracture, rebalance the VC without any motion limitation, avoid external long-roll brace, and eliminate clinical symptoms. The procedure is minimally invasive, fast, and clinically effective. However, the technique should be restricted only to carefully selected clinical cases.

A study on the puncture method of extrapedicular infiltration anesthesia applied during lumbar percutaneous vertebroplasty or percutaneous kyphoplasty

“…Extrapedicular PVP (PKP) was 1st used in the upper and midthoracic vertebrae and was gradually applied to the lower thoracic and lumbar vertebrae. [16,17,18] The primary advantages of extrapedicular PVP (PKP) are that the puncture needle can easily reach the anterior-middle 1/3 point on the middle line of the vertebral body for PVP and easily reach the middle point on the middle line of the vertebral body for PKP. Additionally, bilateral puncture is not required, reducing the operative time and decreasing the radiation frequency.…”

Effects of rosuvastatin and zoledronic acid in combination on the recovery of senile osteoporotic vertebral compression fracture following percutaneous vertebroplasty

“…3 However, its success is somewhat limited because of pain arising from the loss of vertebral height in the later stages of the procedure; this also causes refracture of adjacent centrums, and it severely compromises patients’ quality of life. 4,5 Zoledronic acid, a novel drug used in the clinical treatment of osteoporosis, can accelerate fracture healing and reduce the refracture risk. Recent studies have suggested that statins can inhibit osteoclasts and promote osteogenesis.…”