Procedures:
- Balloon Kyphoplasty .
- Insertion of bone cement under low pressure at .
- Biopsy was medically necessary.
Date of Procedure:
Clinical History: is a y/o with . Comment on available imaging.
Operators: Drs.
Medications: Lidocaine 1% local, Versed mg IV, Fentanyl mcg IV, Dilaudid, Benadryl 50 mg IV, Ancef 1 gram IV.
Fluoroscopy time: minutes
Complications: None immediate.
Technique:
After discussing the risks, benefits, and alternatives to the procedure and sedation, witnessed informed consent was obtained. A time out was performed to verify patient identity and procedure.
The patient was placed prone on the Angiography table. The back was prepped and draped in the usual sterile fashion. The C-Arm was brought into position and the pedicles were identified and marked on the skin with a sterile marker. In view of the pedicle size and collapse of the which level? fracture(s), a transpedicular approach into the vertebral body was determined appropriate.
Under fluoroscopic guidance and through a left/right transpedicular approach, an 11-gauge trocar needle was advanced to just beyond the junction of the pedicle and level vertebral body. Needle tip position was confirmed in the AP and lateral planes to ensure the medial wall of the pedicle was not violated. At this point, the inner needle stylet was removed and a biopsy cannula advanced coaxially into the vertebral body to obtain a core specimen. The stylet needle was replaced into the outer cannula and the trocar advanced to the anterior third of the vertebral body towards/across the midline under multiplanar fluoroscopic guidance.
Attention was then turned to the contralateral side, where under fluoroscopic guidance via a left/right transpedicular approach, an 11-gauge trocar was advanced to just beyond the junction of the pedicle and which level? vertebral body. Needle tip position was confirmed in the AP and lateral planes to ensure the medial wall of the pedicle was not violated. The trocar was then advanced to the anterior third of the vertebral body towards/across the midline under multiplanar fluoroscopic guidance.
After completing the bilateral trocar entry into the vertebral body, mm inflatable bone tamps were inserted through each cannula respectively and advanced under lateral fluoroscopic guidance into the vertebral body proximal to the anterior cortex. The balloon tamps were unsheathed such that the radiopaque marker bands were identified outside the cannula.
Under multiplanar fluoroscopic imaging, the balloon bone tamps were inflated to 0.5 cc and 50 psi. Expansion of the bone tamps was done sequentially in increments of 0.25 to 0.5 cc of contrast, with careful attention being paid to the inflation pressures and balloon positions. The inflations were monitored with AP and lateral imaging. The final balloon volumes were cc on the left and cc on the right. There was no breach of the lateral wall or anterior cortex of the vertebral body. There was partial reduction of the fracture and with the use of the bone void filler device, internal fixation was achieved with low pressure injection of [type] bone cement. The cavity was filled with a total volume of cc. Once the bone cement had hardened, the cannulas were then removed.
Post-procedure, excellent hemostasis was achieved at the small 5 mm puncture sites with manual compression. A sterile dressing was applied. The patient was kept in the prone position for approximately 10 minutes post cement injection before being transferred to a gurney and then the recovery area.
The patient tolerated the procedure well without complications.
Findings:
- % type fracture of level.
- Excellent homogeneous midline PMMA interdigitation without extravasation.
Impression:
Successful Kyphoplasty of compression fracture(s) with bone biopsy.