Roberto Luigi Cazzato1, Pierre de Marini2, Pierre Auloge2, Pierre Alexis Autreausseau2, Guillaume Koch2, Danoob Dalili3,4, Pramod Rao5, Julien Garnon2, Afshin Gangi2. 1. Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, BP 426, 67091, Strasbourg Cedex, France. roberto-luigi.cazzato@chru-strasbourg.com. 2. Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, BP 426, 67091, Strasbourg Cedex, France. 3. Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK. 4. School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK. 5. Service de Radiologie, Hôpitaux Civils de Colmar, Colmar, 39 Avenue de la Liberté, 68024, Colmar, France.
Abstract
OBJECTIVES: Percutaneous vertebroplasty (PV) of the cervical spine has been traditionally performed with a trans-oral or antero-lateral approach. The posterior trans-pedicular approach (PTPA) has been sporadically reported. Therefore, the aim of this study is to retrospectively assess the technical feasibility, safety, and clinical outcomes of cervical PV performed with a PTPA. METHODS: All consecutive patients undergoing PV in cervical levels with PTPA (under general anesthesia and computed tomography [CT] guidance) from January 2008 to November 2019 were identified. The following data were collected: patients' demographics; indication for PV; vertebral level features; procedure-related variables; and clinical outcomes including complications and pain relief. RESULTS: Thirty-two patients (18 females, 14 males; mean age 61.1 ± 13.2 years, range 36-88) were included accounting for 36 vertebrae. Three vertebrae (3/36, 8%) were referred due to an underlying traumatic fracture, the remaining (33/36, 92%) due to a painful lytic tumor. Technical success was 97% (35/36 levels). Mean time required to deploy the trocar was 23 ± 11 min (range 7-60). Extra-vertebral asymptomatic cement leakage was observed in 3/35 (9%) vertebral levels. One patient (1/32, 3%) developed an acute cardiogenic pulmonary edema requiring admission in the intensive care unit; another patient (1/32, 3%) developed localized infection to the skin entry site, which was managed conservatively. At 1-month follow-up, the mean pain in the study population was 1.0 ± 1.1 (range 0-4/10) vs 6.2 ± 1.4 (range 4-9/10) at baseline (p < 0.05). CONCLUSIONS: Cervical PV performed via a CT-guided PTPA is technically feasible, safe, and results in effective pain relief. KEY POINTS: • Percutaneous vertebroplasty (PV) is a well-established technique for the treatment of benign and malignant compression fractures. • Common PV approaches used for cervical vertebrae include the trans-oral, antero-lateral, lateral, and sporadically the posterior trans-pedicular approach. • Retrospective analysis of our 11-year experience with the posterior trans-pedicular approach used for cervical vertebrae proved that such approach was safe and effective.
OBJECTIVES: Percutaneous vertebroplasty (PV) of the cervical spine has been traditionally performed with a trans-oral or antero-lateral approach. The posterior trans-pedicular approach (PTPA) has been sporadically reported. Therefore, the aim of this study is to retrospectively assess the technical feasibility, safety, and clinical outcomes of cervical PV performed with a PTPA. METHODS: All consecutive patients undergoing PV in cervical levels with PTPA (under general anesthesia and computed tomography [CT] guidance) from January 2008 to November 2019 were identified. The following data were collected: patients' demographics; indication for PV; vertebral level features; procedure-related variables; and clinical outcomes including complications and pain relief. RESULTS: Thirty-two patients (18 females, 14 males; mean age 61.1 ± 13.2 years, range 36-88) were included accounting for 36 vertebrae. Three vertebrae (3/36, 8%) were referred due to an underlying traumatic fracture, the remaining (33/36, 92%) due to a painful lytic tumor. Technical success was 97% (35/36 levels). Mean time required to deploy the trocar was 23 ± 11 min (range 7-60). Extra-vertebral asymptomatic cement leakage was observed in 3/35 (9%) vertebral levels. One patient (1/32, 3%) developed an acute cardiogenic pulmonary edema requiring admission in the intensive care unit; another patient (1/32, 3%) developed localized infection to the skin entry site, which was managed conservatively. At 1-month follow-up, the mean pain in the study population was 1.0 ± 1.1 (range 0-4/10) vs 6.2 ± 1.4 (range 4-9/10) at baseline (p < 0.05). CONCLUSIONS: Cervical PV performed via a CT-guided PTPA is technically feasible, safe, and results in effective pain relief. KEY POINTS: • Percutaneous vertebroplasty (PV) is a well-established technique for the treatment of benign and malignant compression fractures. • Common PV approaches used for cervical vertebrae include the trans-oral, antero-lateral, lateral, and sporadically the posterior trans-pedicular approach. • Retrospective analysis of our 11-year experience with the posterior trans-pedicular approach used for cervical vertebrae proved that such approach was safe and effective.