title: Transdiscal mid- and upper thoracic vertebroplasty: first description of 2 exemplary cases.
abstract: Kyphoplasty and vertebroplasty are established treatment methods to reinforce fractured vertebral bodies. In cases of previous pedicle screw instrumentation, vertebral body cannulation may be challenging. The authors describe, for the first time, an approach through the adjacent inferior vertebra and disc space in the thoracic spine for cement augmentation. A 78-year-old woman underwent posterior fusion with pedicle screws after vertebrectomy and reconstruction with cement and Steinmann pins for a pathological T-7 fracture. Two months later she developed a compression fracture of the vertebral body at the lower part of the construct, and a vertebroplasty was performed. Because a standard transpedicular route was not available, an inferior transdiscal trajectory was used for the cement injection. A 73-year-old man with a history of rheumatoid arthritis underwent cervicothoracic fusion posteriorly for subluxation. He developed pain in the upper thoracic area, and the authors performed a transdiscal vertebroplasty at T-2. The standard transpedicular route was not possible. The vertebral body was satisfactorily filled up with cement. Clinically both patients benefited significantly in terms of back pain and showed an uneventful follow-up of 3 months. Transdiscal vertebroplasty can achieve good results in the mid- and upper thoracic spine when a standard transpedicular trajectory is not possible, and can therefore be a good alternative in select cases.
authors.affiliation: Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida; and.
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Filis
authors.affiliation: Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida; and.
authors.forename: Kamran
authors.initials: K
authors.lastname: Aghayev
authors.affiliation: University of Oxford, United Kingdom.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schaller
authors.affiliation: Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida; and.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Luksza
authors.affiliation: Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida; and.
authors.forename: Frank D
authors.initials: FD
authors.lastname: Vrionis
mesh_terms: D000368:Aged; D001416:Back Pain / Q000000981:diagnostic imaging / Q000601:surgery; D001843:Bone Cements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019904:Polymethyl Methacrylate; D012086:Reoperation; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D054854:Vertebroplasty / Q000379:methods*
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate
keywords: PMMA = polymethylmethacrylate; fusion; kyphoplasty; technique; thoracic; transdiscal trajectory; vertebroplasty