Abstract
Vertebral compression fractures (VCFs) represent a significant cause of disability and primarily result from either underlying vertebral body neoplasms or osteoporosis. Vertebroplasty (VP) is a procedure commonly utilized to repair pathologic VCFs in order to manage pain and reinstate vertebral body height. However, there is a paucity of literature on how to manage painful multilevel VCFs with concomitant bilateral pedicle fractures. We describe a patient with a primary prostatic carcinoma and VCFs of the third and fourth lumbar vertebrae (L3 and L4, respectively) with concomitant bilateral pedicle fractures secondary to metastatic disease. Due to the degree of damage to the L3 and L4 vertebral bodies and pedicles, a VP performed via a percutaneous approach was deemed to be too high risk. VP for L3 and L4 was instead performed by utilizing stereotactic spine navigation and an intraoperative O-arm (Medtronic Corporation, Minneapolis, Minnesota). Our result indicates a potential role for stereotactic spine navigation in vertebroplasty for complex pathologic VCFs.
Highlights
In patients with underlying malignancy, the bones are the third-most common site of primary tumor spread [1]
We describe a patient with a primary prostatic carcinoma and Vertebral compression fractures (VCFs) of the third and fourth lumbar vertebrae (L3 and L4, respectively) with concomitant bilateral pedicle fractures secondary to metastatic disease
Our result indicates a potential role for stereotactic spine navigation in vertebroplasty for complex pathologic VCFs
Summary
In patients with underlying malignancy, the bones are the third-most common site of primary tumor spread [1]. Percutaneous VP has been avoided in cases of VCF with concomitant pedicle fracture due to concerns of exacerbating spinal instability In this technical report, we describe a novel surgical technique using stereotactic spine navigation and an intraoperative O-arm surgical imaging system (Medtronic Corporation, Minneapolis, Minnesota) to perform multilevel VP for a patient with metastatic disease of the third and fourth lumbar vertebrae (L3 and L4, respectively) with concomitant bilateral pedicle fractures. A small Stealth guided tubular dilator retractor (Medtronic Corporation, Minneapolis, Minnesota) was introduced at the location of the left L3 pedicle (Figure 2B). A Kyphon cannula (Medtronic Corporation, Minneapolis, Minnesota) was introduced through the guidewire down into the vertebral body (Figure 2E) These steps were repeated on the bilateral pedicles of the L3 and L4 vertebrae. Blue arrows delineate extravasated cement from the L4 vertebral body into the L4-L5 disc space
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