A modified trajectory of kyphoplasty via superior pedicle notch for osteoporotic vertebral compression fractures: Technique note and clinical result

Abstract

BackgroundPercutaneous extra-pedicular kyphoplasty can achieve better clinical results than transpedicular kyphoplasty. However, lumbar segment artery injury as a disaster complication limits its clinical application.ObjectiveTo describe and evaluate a modified trajectory of kyphoplasty for the treatment of osteoporotic vertebral compression fractures (OVCF).MethodsEighty-one patients who underwent percutaneous kyphoplasty (PKP) for lumbar OVCF at our hospital between May 2017 and May 2021 were enrolled. The patients were divided into an observation group (via the superior pedicle approach) and a control group (via the transpedicular approach) according to the surgical trajectory. The surgical procedure was described in detail, and the imaging parameters were recorded. Preoperative and postoperative clinical data were collected for statistical analysis.ResultsPKP via the superior pedicle notch approach could offer large abduction and cranial inclination angles without serious complications. The rate of paravertebral leakage was significantly lower in the observation group than in the control group. Surgery with a superior pedicle notch approach had a shorter operative time and fewer fluoroscopies.ConclusionsPKP via the superior pedicle notch approach is a modified extra-pedicular approach for lumbar osteoporotic vertebral compression fractures. This trajectory is an easy-to-use target position because it enters the vertebral body directly. A shorter operative time and lower radiation exposure can enhance recovery after surgery.

Spinal Endoscopy-Targeted Bone Grafting for the Vertebral “Shell” Phenomenon: A Case Report

“…At present, grafting of the injured vertebral bone primarily involves intravertebral bone grafting via the narrow vertebral pedicle channels, increasing treatment difficulty and possibly leading to complications such as vertebral pedicle fracture and nerve root injury [8]. In contrast, bone grafting via superior pedicle notch approach is a relatively safer approach [9,10]. The superior pedicle notch is located below the intervertebral foramen and is a "safe zone" with no vascular nerves in the surroundings.…”

“…The superior pedicle notch is located below the intervertebral foramen and is a "safe zone" with no vascular nerves in the surroundings. Jiang et al [10] have reported that the superior pedicle notch approach to PVP has a higher angle of abduction and sagittal view, therefore preventing neurovascular injury and decreasing radiation exposure and operation time. The superior pedicle notch is located in the upper one-third of the vertebral body and is adjacent to the "shell", providing an anatomical basis for the reconstruction of the injured spine.…”