Percutaneous vertebroplasty after posterior spinal fusion: importance of CT guidance and role of interventional radiologist.

Congress:

ECR 2020

Poster Number:

C-03765

Type:

Scientific Exhibit

Keywords:

Performed at one institution, Observational, Retrospective, Trauma, Vertebroplasty, Fluoroscopy, CT, Musculoskeletal spine, Interventional non-vascular, Interventional Radiology

Authors:

L. J. Pavan¹, A. Rudel¹, O. Clerk-Lamalice², F. Torre¹, A. PRESTAT¹, D. S. Palominos Pose³, C. RANC¹, H. VASSEUR¹, N. Amoretti¹; ¹Nice/FR, ²Edmonton/CA, ³Santiago de Chile/CL

DOI:

10.26044/ecr2020/C-03765

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-03765

Table 1: Inclusion criteria.

Table 2: Patients' demographics. MVA=motor vehicle accident, PP=parapedicular,...

Fig. 1: Vertebral access. a) Setting of PVP procedure under combined guidance; b)...

$Fig. 2: PVP reprise. a) axial PET-CT and (b) coronal CT scan showing persistence of a non-consolidated fracture on the right side of vertebral body of T5 after a first PVP; c) axial and (d) coronal CT scan views after PVP reprise.$

Fig. 2: PVP reprise. a) axial PET-CT and (b) coronal CT scan showing persistence of a...

Purpose

Aim of the study is to evaluate the feasibility and efficacy of percutaneous vertebroplasty (PVP), under combined fluoroscopic and CT guidance, in patients with painful vertebral body non-union/osteonecrosis after posterior spinal fusion (PSF) for an unstable non-neurologic traumatic vertebral fracture.

Methods and materials

All patients treated in our radiology unit with PVP between July 2015 and June 2016 were reviewed. We retrospectively selected patients who underwent PVP for symptomatic vertebral body non-union/osteonecrosis of an unstable traumatic vertebral fracture previously treated with PSF. All selected patients had clinical and imaging evidence of painful vertebral body non-union/osteonecrosis and none of them was treated with anterior stabilization or vertebral augmentation together with PSF (Tab. 1). All procedures were carried out by two experienced musculoskeletal interventional radiologists under combined fluoroscopic and CT...

Results

Ten patients were selected (mean age 53±12y) with a mean time between PSF and PVP of 9.6 months. They all had a previous history of high energy traumatic injury (fall, motor vehicle or sport accident) (Tab. 2). Different vertebral body accesses were chosen according to fracture location within the vertebral body, but mainly to avoid orthopedic hardware. Parapedicular approach was the most frequently used technique to access vertebral body (8/10 patients), while only two vertebrae were treated with transpedicular accesses (Fig. 1). Two patients required...

Conclusion

Our series shows that PVP performed under combined fluoroscopic and CT guidance is a safe and effective technique to treat post-traumatic vertebral body non-union/osteonecrosis in patients previously undergone PSF, allowing to spare a major surgical reintervention. Techniques using either fluoroscopic guidance [2] or biplanar fluoroscopic [3] have been described to avoid spinal hardware in vertebroplasty, but the utility of combined CT and fluoroscopic guidance has not been reported yet. CT guidance adds precious information to correctly choose the vertebral access, to avoid conflicts with orthopaedic...

Personal information and conflict of interest

L. J. Pavan; Nice/FR - nothing to disclose F. Torre; Nice/FR - nothing to disclose A. Prestat; Nice/FR - nothing to disclose N. Amoretti; Nice/FR - nothing to disclose C. Ranc; Nice/FR - nothing to disclose A. Rudel; Nice/FR - nothing to disclose D. S. Palominos Pose; Santiago de Chile/CL - nothing to disclose H. Vasseur; Nice/FR - nothing to disclose O. Clerk-Lamalice; Edmonton/CA - nothing to disclose

References

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