Percutaneous vertebroplasty of the cervical spine performed via a posterior trans-pedicular approach
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INTERVENTIONAL
Percutaneous vertebroplasty of the cervical spine performed via a posterior trans-pedicular approach Roberto Luigi Cazzato 1 & Pierre de Marini 1 & Pierre Auloge 1 & Pierre Alexis Autreausseau 1 & Guillaume Koch 1 & Danoob Dalili 2,3 & Pramod Rao 4 & Julien Garnon 1 & Afshin Gangi 1 Received: 16 June 2020 / Accepted: 14 August 2020 # European Society of Radiology 2020
Abstract Objectives Percutaneous vertebroplasty (PV) of the cervical spine has been traditionally performed with a trans-oral or anterolateral 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. Keywords Vertebroplasty . Cervical vertebrae . Spinal neoplasms
* Roberto Luigi Cazzato [email protected] 1
Service d’Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1 place de l’hôpital, BP 426, 67091 Strasbourg Cedex, France
2
Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford OX3 7LD, UK
3
School of Biomedical Engineering and Imaging Sciences, King’s College
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