Percutaneous vertebroplasty through a transdiscal access route after lumbar transpedicular instrumentation.
BACKGROUND
Transpedicular vertebroplasty is an effective procedure to reduce pain and stabilize osteoporotic vertebral fractures. It is, however, difficult to perform after transpedicular instrumentation because the pedicle screws are in the way.


OBJECTIVE
To determine if vertebroplasty can be performed in patients who have previously undergone osteosynthesis pedicle-screw fixation.


METHODS
We postulate that an alternate transdiscal route can be used in cases with instrumentation in order to successfully perform vertebroplasty.


METHODS
We report the case of a 73-year-old male patient presenting with a fresh osteoporotic fracture of L2 and L3 6 weeks after having undergone a dorsal operative stabilization between L3 and L5.


RESULTS
Vertebroplasty was performed using a transdiscal descending approach to treat the two adjacent vertebral levels. The patient reported a 50% decrease in pain and was able to walk with a stick at 3 months. At late follow-up at 18 months his walking had further improved and he experienced only sporadic lumbar pain.


CONCLUSIONS
Vertebroplasty can be performed in patients having previously undergone transpedicular instrumentation. The transdiscal route represents such a new approach.
Mehdizade
Amir
A
Department of Radiology, University Hospital of Geneva, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland.
Payer
Michael
M
Somon
Thierry
T
Willhelm
K
K
Kelekis
Alexis
A
Wetzel
Stephan
S
Palmesino
Marco
M
Lovblad
Karl-Olof
KO
Rufenacht
Daniel A
DA
Martin
Jean-Baptiste
JB
D000058:Accidental Falls; D000368:Aged; D016025:Bone Transplantation / Q000379:methods; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D007796:Laminectomy / Q000295:instrumentation* / Q000379:methods; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009192:Myelography / Q000379:methods; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging; D018570:Risk Assessment; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome