title: Percutaneous vertebroplasty through a transdiscal access route after lumbar transpedicular instrumentation.
abstract: 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.
authors.affiliation: Department of Radiology, University Hospital of Geneva, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland.
authors.forename: Amir
authors.initials: A
authors.lastname: Mehdizade
authors.forename: Michael
authors.initials: M
authors.lastname: Payer
authors.forename: Thierry
authors.initials: T
authors.lastname: Somon
authors.forename: K
authors.initials: K
authors.lastname: Willhelm
authors.forename: Alexis
authors.initials: A
authors.lastname: Kelekis
authors.forename: Stephan
authors.initials: S
authors.lastname: Wetzel
authors.forename: Marco
authors.initials: M
authors.lastname: Palmesino
authors.forename: Karl-Olof
authors.initials: KO
authors.lastname: Lovblad
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Rufenacht
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Martin
mesh_terms: 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