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CT-Guided Percutaneous Vertebroplasty for Vertebral Non-union Following Posterior Fixation: A Preliminary Retrospective Study

  • Clinical Investigation
  • Non-Vascular Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

A Correction to this article was published on 14 March 2022

This article has been updated

Abstract

Purpose

Traumatic thoracolumbar vertebral fractures are frequently treated with posterior fixation (PF) and vertebral augmentation. Sometimes, it is deemed too risky to offer vertebral augmentation under fluoroscopic guidance alone. Adjuvant CT/fluoroscopy-guided percutaneous vertebroplasty (PVP) could be offered in certain scenarios. The aim was to evaluate feasibility, safety and effectiveness of PVP in patients presenting with vertebral non-union (VNU) following PF performed without concomitant vertebral augmentation.

Materials and Methods

All patients treated in our institution with PVP between July 2015 and July 2020 were retrospectively reviewed. Patients treated with CT/fluoroscopy-guided PVP under local anesthesia for symptomatic VNU following PF were selected. Three criteria were established to assess cement distribution, considering vertebral filling of: (1) fracture cleft, (2) anterior two-thirds of the vertebral body, (3) from superior to inferior endplates. Numeric pain rating scale (NPRS) assessing grade of discomfort (0 = no pain; 10 = worst pain) and complications were evaluated before and 1 month after PVP.

Results

Ten patients were identified (mean age 53 ± 12y). Mean time between PF and PVP was 9.6 [2–35] months. Two patients required further cement injection with a second PVP. Eight patients had satisfactory vertebral filling according to the three criteria. Mean NPRS reduction was 2.7(-42%, p < 0.05). No significant complications occurred.

Conclusions

Combined CT/fluoroscopy guidance seems a useful tool to perform PVP in VNU following PF, even in presence of orthopedic metalwork. Interventional radiologists may help in these scenarios, performing an adjuvant PVP under local anesthesia. In this small series, the procedure seems safe and effective and could be taken in consideration as alternative to revision surgery.

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Data Availability

Raw data supporting the conclusions of this manuscript can be made available by the authors to any qualified researcher without undue reservation.

Change history

Abbreviations

A.O. Spine:

A. O. Spine Classification of Thoracolumbar Fractures

CT:

Computed Tomography

NPRS:

Numeric Pain Rating Scale

PF:

Posterior Fixation

PMMA:

Polymethyl-Methacrylate

PVP:

Percutaneous Vertebroplasty

SSPF:

Short-Segment Posterior Fixation

LSPF:

Long-Segment Posterior Fixation

VB:

Vertebral Body

References

  1. Verlaan JJ, Diekerhof CH, Buskens E, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine. 2004;29(7):803–14. https://doi.org/10.1097/01.brs.0000116990.31984.a9.

    Article  CAS  PubMed  Google Scholar 

  2. Liang C, Liu G, Liang G, et al. Healing pattern classification for thoracolumbar burst fractures after posterior short-segment fixation. BMC Musculoskelet Disord. 2020;21(1):373. https://doi.org/10.1186/s12891-020-03386-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Park S-R, Na H-Y, Kim J-M, Eun D-C, Son E-Y. More than 5-year follow-up results of two-level and three-level posterior fixations of thoracolumbar burst fractures with load-sharing scores of seven and eight point. Clin Orthop Surg. 2016;8(1):71–7. https://doi.org/10.4055/cios.2016.8.1.71.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Benson DR, Burkus JK, Montesano PX, Sutherland TB, McLain RF. Unstable thoracolumbar and lumbar burst fractures treated with the AO fixateur interne. J Spinal Disord. 1992;5(3):335–43. https://doi.org/10.1097/00002517-199209000-00012.

    Article  CAS  PubMed  Google Scholar 

  5. Kramer DL, Rodgers WB, Mansfield FL. Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system. J Orthop Trauma. 1995;9(6):499–506. https://doi.org/10.1097/00005131-199509060-00007.

    Article  CAS  PubMed  Google Scholar 

  6. Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop. 1984;189:65–76.

    Google Scholar 

  7. Korovessis P, Mpountogianni E, Syrimpeis V. Percutaneous pedicle screw fixation plus kyphoplasty for thoracolumbar fractures A2, A3 and B2. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2017;26(5):1492–8. https://doi.org/10.1007/s00586-016-4743-6.

    Article  Google Scholar 

  8. Percutaneous fixation of thoracolumbar fractures: Current concepts | Elsevier Enhanced Reader. https://doi.org/10.1016/j.otsr.2012.09.014

  9. CIRSE Guidelines on Percutaneous Vertebral Augmentation | SpringerLink. Accessed August 23, 2021. https://doi.org/10.1007/s00270-017-1574-8

  10. Vaccaro AR, Oner C, Kepler CK, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine. 2013;38(23):2028–37. https://doi.org/10.1097/BRS.0b013e3182a8a381.

    Article  PubMed  Google Scholar 

  11. Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine. 2005;30(11):1331–4. https://doi.org/10.1097/01.brs.0000164099.92112.29.

    Article  PubMed  Google Scholar 

  12. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: The Cirse cassification system. Cardiovasc Intervent Radiol. 2017;40(8):1141–6. https://doi.org/10.1007/s00270-017-1703-4.

    Article  CAS  PubMed  Google Scholar 

  13. Kim B-G, Dan J-M, Shin D-E. Treatment of thoracolumbar fracture. Asian Spine J. 2015;9(1):133–46. https://doi.org/10.4184/asj.2015.9.1.133.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bironneau A, Bouquet C, Millet-Barbe B, Leclercq N, Pries P, Gayet L-E. Percutaneous internal fixation combined with kyphoplasty for neurologically intact thoracolumbar fractures: a prospective cohort study of 24 patients with one year of follow-up. Orthop Traumatol Surg Res OTSR. 2011;97(4):389–95. https://doi.org/10.1016/j.otsr.2011.02.009.

    Article  CAS  PubMed  Google Scholar 

  15. Korovessis P, Repantis T, Petsinis G, Iliopoulos P, Hadjipavlou A. Direct reduction of thoracolumbar burst fractures by means of balloon kyphoplasty with calcium phosphate and stabilization with pedicle-screw instrumentation and fusion. Spine. 2008;33(4):E100-108. https://doi.org/10.1097/BRS.0b013e3181646b07.

    Article  PubMed  Google Scholar 

  16. Bu BX, Wang MJ, Liu WF, Wang YS, Tan HL. Short-segment posterior instrumentation combined with calcium sulfate cement vertebroplasty for thoracolumbar compression fractures: radiographic outcomes including nonunion and other complications. Orthop Traumatol Surg Res OTSR. 2015;101(2):227–33. https://doi.org/10.1016/j.otsr.2014.11.019.

    Article  CAS  PubMed  Google Scholar 

  17. Delawi D, Dhert WJA, Castelein RM, Verbout AJ, Oner FC. The incidence of donor site pain after bone graft harvesting from the posterior iliac crest may be overestimated: a study on spine fracture patients. Spine. 2007;32(17):1865–8. https://doi.org/10.1097/BRS.0b013e318107674e.

    Article  PubMed  Google Scholar 

  18. Rihn JA, Kirkpatrick K, Albert TJ. Graft options in posterolateral and posterior interbody lumbar fusion. Spine. 2010;35(17):1629–39. https://doi.org/10.1097/BRS.0b013e3181d25803.

    Article  PubMed  Google Scholar 

  19. Amoretti N, Bertrand A-S, Gallo G, et al. Percutaneous consolidation of loosened spine arthrodesis under CT and fluoroscopy guidance by radiologists: a new useful technique. Eur Radiol. 2015;25(4):1135–9. https://doi.org/10.1007/s00330-014-3475-4.

    Article  PubMed  Google Scholar 

  20. Beall DP, Braswell JJ, Martin HD, Stapp AM, Puckett TA, Stechison MT. Technical strategies and anatomic considerations for parapedicular access to thoracic and lumbar vertebral bodies. Skeletal Radiol. 2007;36(1):47–52. https://doi.org/10.1007/s00256-006-0192-3.

    Article  PubMed  Google Scholar 

  21. Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149–58. https://doi.org/10.1016/s0304-3959(01)00349-9.

    Article  PubMed  Google Scholar 

  22. Aono H, Ishii K, Tobimatsu H, et al. Temporary short-segment pedicle screw fixation for thoracolumbar burst fractures: comparative study with or without vertebroplasty. Spine J Off J North Am Spine Soc. 2017;17(8):1113–9. https://doi.org/10.1016/j.spinee.2017.03.022.

    Article  Google Scholar 

  23. He S, Lin L, Tang X, et al. The treatment of osteoporotic thoracolumbar severe burst fractures with short pedicle screw fixation and vertebroplasty. Acta Orthop Belg. 2014;80(4):493–500.

    PubMed  Google Scholar 

  24. Saracen A, Kotwica Z. Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients. Medicine (Baltimore). 2016;95(24): e3850. https://doi.org/10.1097/MD.0000000000003850.

    Article  Google Scholar 

  25. Zhao Q, Zhang H, Hao D, Guo H, Wang B, He B. Complications of percutaneous pedicle screw fixation in treating thoracolumbar and lumbar fracture. Medicine (Baltimore). 2018;97(29): e11560. https://doi.org/10.1097/MD.0000000000011560.

    Article  Google Scholar 

  26. Linhares D, Fonseca JA, Ribeiro da Silva M, et al. Cost effectiveness of outpatient lumbar discectomy. Cost Eff Resour Alloc. 2021;19(1):19. https://doi.org/10.1186/s12962-021-00272-w

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Acknowledgements

The authors would like to acknowledge the patients that participated in the study, the nurses and technical personnel working at our Interventional Radiology Department.

Funding

No sponsor was involved in any of the study steps: design, data collection, analysis, interpretation, writing of the report and submission.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Nice University Hospital, Hôpital Pasteur 2, Nice, France

    Luca Jacopo Pavan, Caroline Ranc, Federico Torre, Robert Burns, Olivier Andreani, Paul Alexis Ranc, Alexandre Prestat & Nicolas Amoretti

  2. South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, London, KT18 7EG, UK

    Danoob Dalili

  3. Epsom and St Helier University Hospitals NHS Trust, Dorking Road, Epsom, London, KT18 7EG, UK

    Danoob Dalili

  4. Radiology Department, University of Calgary, Calgary, AB, Canada

    Olivier Clerk-Lamalice

  5. Spine Surgery - University Institute of Locomotion and Sports, Nice University Hospital, Hôpital Pasteur 2, Nice, France

    Nicolas Bronsard

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  1. Luca Jacopo Pavan
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Correspondence to Luca Jacopo Pavan.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Ethical Statement

This retrospective observational study was conducted in accordance with the Declaration of Helsinki. The participating parents provided an informed consent in accordance with the Declaration of Helsinki. No ethical committee approval was required for the retrospective nature of the study.

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Study Number: ClinicalTrials.gov Identifier NCT05071625.

The original online version of this article was revised: Erratum is made due to several errors in the affiliations of the authors, in the initial publication.

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Pavan, L.J., Dalili, D., Ranc, C. et al. CT-Guided Percutaneous Vertebroplasty for Vertebral Non-union Following Posterior Fixation: A Preliminary Retrospective Study. Cardiovasc Intervent Radiol 45, 687–695 (2022). https://doi.org/10.1007/s00270-021-03037-3

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  • DOI: https://doi.org/10.1007/s00270-021-03037-3

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