Vertebroplasty in the mid- and upper thoracic spine.
OBJECTIVE
Vertebroplasty performed in the mid- and upper thoracic spine presents technical challenges that differ from those in the lower thoracic and lumbar region. We herein report results of percutaneous vertebroplasty for treatment of painful, osteoporotic compression fractures in the mid- and upper thoracic spine.


METHODS
Retrospective chart review identified vertebroplasty treatments performed for painful osteoporotic compression fractures at T4-T8. The following were catalogued: percentage of vertebral body compression, needle size, surgical approach, clinical outcome, volume of cement injected, and complications.


RESULTS
Sixty-three vertebral bodies were treated in 41 patients. Mean percentage of compression was 44%. Bipediculate injections were used in 12 (19%) of 63 treatment levels, and unipediculate injections were used in 51 (81%) of treatments (75 injections performed). Eleven-gauge needles were used for 55 (73%) of the 75 injections, and 13-gauge needles were used for 20 (27%). Clinical follow-up was available for 76% of the patients. Mean pre- and postoperative pain intensity was 9.7 +/- 1.0 and 1.7 +/- 1.9, respectively (P <.0001). Mean pre- and postoperative medication scores were 3.4 +/- 0.7 and 1.7 +/- 1.7, respectively (P =.075). Fracture involving the pedicle used for needle access was noted in one (1.3%) of 75 injections; this pedicle had been traversed using a 13-gauge needle. Staphylococcus epidermidis infection occurred in one case. No cases of pneumothorax were noted.


CONCLUSIONS
Transpedicular vertebroplasty is readily and safely performed using 11-gauge needles in the mid- and upper thoracic regions, yielding excellent pain relief and low complication rates.
Kallmes
David F
DF
Department of Radiology, University of Virginia Health Services, Charlottesville, VA 22908, USA.
Schweickert
Patricia A
PA
Marx
William F
WF
Jensen
Mary E
ME
D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal; D019060:Minimally Invasive Surgical Procedures; D010024:Osteoporosis / Q000150:complications* / Q000628:therapy*; D010146:Pain / Q000209:etiology; D059408:Pain Management; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000209:etiology* / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome; D014768:Virginia