title: Kyphoplasty for vertebral compression fracture via a uni-pedicular approach.
abstract: BACKGROUND
  Percutaneous kyphoplasty using a bone expander polymer device, such as percutaneous vertebroplasty and balloon kyphoplasty, is a therapeutic intervention for painful osteoporotic vertebral body compression fractures. Typically the procedure involves placement of bilateral Sky Bone Expanders in the fractured vertebral body via a transpedicular approach. We describe performance of "SKy"phoplasty using the Disc-O-Tech Sky Bone Expander (Disc-O-Tech Medical Technologies, Herzliya, Israel, and Monroe Township, New Jersey) via a unilateral transpedicular approach. The advantage of a unilateral approach is that it reduces the risks associated with large-bore needle placement. These risks include pedicle fracture, medial transgression of the pedicle or transgression into the spinal canal, nerve injury, cement leakage along the cannula tract, and spinal epidural hematoma. Additionally, using a unilateral approach reduces operative time and costs.
  
  
  METHODS
  A 68-year-old man with osteoporosis presented with severe upper back pain which occurred following a fall. The pain was reproducible on palpation of the L1 spinous process. A lumbar spine magnetic resonance imaging (MRI) with STIR (short tau inversion recovery) sequence demonstrated an acute L1 vertebral body compression fracture. A L1 "SKy"phoplasty was performed using a single Sky Bone Expander polymer device via a unilateral transpedicular approach. The patient reported immediate relief of pain after the procedure. He denied any residual back pain at his follow-up visit. He was able to resume his normal activities including walking, which had been inhibited by pain prior to the procedure.
  
  
  CONCLUSIONS
  "SKy"phoplasty can be performed using a single Sky Bone Expander via a unilateral pedicular approach. The key is a medial needle trajectory with a final Sky Bone Expander position in the midline of the vertebral body.
authors.affiliation: MGH Pain Center, Dept. of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. mhu@painandwellness.com
authors.forename: M Melvin
authors.initials: MM
authors.lastname: Hu
authors.forename: Clifford J
authors.initials: CJ
authors.lastname: Eskey
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Tong
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Pomerantz
authors.forename: James D
authors.initials: JD
authors.lastname: Rabinov
authors.forename: Johnny C
authors.initials: JC
authors.lastname: Pryor
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Hirsch