[Show abstract][Hide abstract] ABSTRACT: Purpose:
To assess the feasibility of computed tomography (CT)- and fluoroscopy-guided percutaneous facet screw fixation following anterior lumbar interbody fusion (ALIF) or anterior pseudarthrosis in adults.
Materials and methods:
Institutional review board approval and informed consent were obtained for this study. One hundred seven consecutive adult patients (46 men, 61 women; mean age ± standard deviation: 56.3 years ± 12.9) with ALIF (n = 79) or anterior pseudarthrosis (n = 28) were prospectively treated by means of percutaneous facet screw fixation with CT and fluoroscopic guidance. Two 4.0-mm cannulated screws were placed per level to fix facet joints by using either a translaminar facet or transfacet pedicle pathway. Only local anesthesia was used during these procedures. Procedural time was noted for each patient. Postoperative follow-up ranging from 1 year to 3 years was assessed by using Macnab and radiologic criteria.
The mean procedure times for a lumbar single-level and a double-level fusion ranged from 15 to 25 minutes and from 40 to 50 minutes, respectively. All the transfacet pedicle (n = 182) and translaminar facet (n = 56) screws were successfully placed in one attempt. Radiographic fusion was observed within the year following posterior fixation in all patients despite one translaminar screw failure. According to the Macnab criteria, the clinical results were classified as excellent in 92 (86%) and good in 15 (14%) of 107 patients at the time of their last follow-up examination.
This feasibility study showed that CT- and fluoroscopy-guided percutaneous facet screw fixation is a rapid, safe, and effective method.
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
The purpose of this study was to assess the feasability of CT- and fluoroscopy-guided percutaneous transfacet screw fixation following anterior lumbar interbody fusion (ALIF) or anterior pseudarthrosis.
METHOD AND MATERIALS
24 consecutive adult patients with ALIF or anterior pseudarthrosis were prospectively treated by percutaneous facet screw fixation under CT and fluoroscopy guidance. The two translaminar facet and transfacetopedicular pathways were used. Only local anesthesia was performed during these procedures.
The mean procedure times for a lumbar single level and for a double level to be fused ranged from 15 to 25 minutes and from 40 to 50 minutes, respectively. All the transfacetopedicular and translaminar screws were successfully placed in only one attempt. Average transfacet screw size was 29 mm long (range, 18 mm - 55 mm). There was no neurologic complication. One translaminar screw failure was observed. Radiographic fusion was observed at 6 months in all the patients.
Our study showed the accuracy of CT-guided percutaneous facet screw fixation following ALIF. New challenges would be the assessment of this minimally invasive technique as a primary fixation. The place of such a technique in the therapeutic management of lumbar fusion remains also to be defined in collaboration with orthopedists who tend increasingly to give priority to less invasive procedures.
CT gudied screw fixation under local anesthesia is an optimal tool to fix the posterior articulation to increase to fusion rate.
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
The purpose of this study was to assess if the presence or not of intravertebral cleft could impact the effectiveness of percutaneous vertebroplasty in 50 adult patients with vertebra plana.
METHOD AND MATERIALS
50 adult patients (14 men and 36 women; mean age: 81 years) with vertebra plana were prospectively treated by percutaneous vertebroplasty. Pre-operative MR imaging (T1-weighted and STIR sequences) was systematically performed. Under CT and fluoroscopy guidance, a 13-gauge 10-cm Trocar t’am (Thiebaud, France) was placed anteriorly and in the middle of the fractured vertebral body using an unilateral inter-costo-vertebral or postero-lateral approach. Then polymethylmethacrylate was injected intra-vertebrally: if present, the intravertebral cleft was filled. Only local anesthesia was used during the whole procedure. Follow-up was done using Visual Analog Scale (VAS) for the severity of pain at Day 1, 1 month, 6 months and 1 year.
Involved vertebra ranged from D6 to L4 with 82% at the thoracolumbar junction. In the group of vertebra plana with cleft (n = 29/50 patients), VAS scores ± standard deviations (SDs) were: preoperatively, 8.1 ± 1.5; at Day 1, 1.3 ± 1.4; at 1 month, 1.2 ± 1.2; at 6 months, 1.3 ± 1.4; and at 1 year, 1.6 ± 1.5. In the group without cleft (n = 21), VAS scores ± SDs were in the same order: 7.5 ± 1.2; 2.4 ± 2.1; 2.0 ± 1.8; 1.9 ± 1.6; and 2.0 ± 1.7. The decrease between pre- and post-operative VAS scores was significantly higher in the group with cleft (p < 0.05 in all cases). There was no neurologic or infectious complication. Cement leakage into disks was observed in 8/50 cases (16%). Seven (14%) adjacent vertebral compression fractures occured during the year of follow-up, and were successfully treated by vertebroplasty.
The results of this study showed that percutaneous vertebroplasty was safe and effective in patients with vertebra plana, with better results when intravertebral cleft was present.
Percutaneous vertebroplasty could be safe and effective in patients with vertebra plana, with better results if intravertebral cleft is present.
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
The purpose of this study was to assess the efficiency of vertebroplasty in split fractures in adult patients.
METHOD AND MATERIALS
50 adult patients (32 men and 18 women; mean age: 48 years) were prospectively treated by percutaneous vertebroplasty for post-traumatic split fractures (Magerl A2). MR imaging was systematically performed preoperatively. Under CT and fluoroscopy guidance, a 13-gauge Trocar t’am (Thiebaud, France) transfixed the fracture line using a bilateral approach which could be transpedicular, intercosto-vertebral or postero-lateral (functions of the topography of fracture line). Polymethylmethacrylate with a consistency of toothpaste was injected on both sides and in the fracture line: a cement bridge was thus made by slowly moving the Trocar back. Only local anesthesia was used during the whole procedure. Follow-up was done using Visual Analog Scale (VAS) for the severity of pain and Oswestry Disability Index (ODI) for functional disability over a period of 2 years.
VAS scores ± standard deviations (SDs) were : preoperatively, 7.5 ± 1.5; at Day 2, 2.1 ± 1.2; and stable after at this low level over the period of 2 years. ODI scores ± SDs were: preoperatively, 65.3 ± 16.2; at Day 2, 16.1 ± 5.0; and stable after. The procedural time was about 15 minutes. Procedures were well tolerated by patients. There was no neurologic or infectious complication. Disk leakages were observed in 7/50 cases (14%), without adjacent vertebral fractures occured over 2 years.
This study showed that percutaneous vertebroplasty was efficient in split fractures with regard to pain and function.
Percutaneous vertebroplasty appears efficient in split fractures with regard to pain and function.
[Show abstract][Hide abstract] ABSTRACT: Objective To evaluate percutaneous computed tomography (CT)-guided intracystic and intra-articular steroid injections for the treatment of lumbar facet joint cyst causing radicular pain. Methods A single-centre prospective study involving 120 consecutive patients with symptomatic lumbar facet joint cyst-induced radicular pain was done (72 women, 48 men). The average age was 68.2 years (52-84). Patients were treated by percutaneous CT-guided intracystic and intra-articular steroid injections. The clinical course of nerve root pain was evaluated after 1 day, and 1, 3 and 6 months, with long-term follow-up after 12 months. Results Patient follow-ups in our series show supportive results: within 120 patients, 54% of patients were satisfied with a long-lasting result from the first intra-cystic and intra-articular steroid injections (n = 65), while 20.8% were satisfied with a long-lasting result from a second intervention. Combining these two results shows that 75% of patients were satisfied with a long-lasting result. Conclusions Our results showed that percutaneous treatment of vertebral lumbar facet joint cysts by double injections is an effective and economic therapeutic technical management among 75% of our patients. Thus we recommend that it should be considered as a first choice of treatment.
• Lumbar facet joint cysts are a common feature of back and radicular pain. • They may be treated effectively by interventional radiologists using CT guidance • Percutaneous treatment using double injections can save surgery in 75% of patients
No preview · Article · Jun 2012 · European Radiology
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To assess the atmospheric concentrations of methyl methacrylate (MMA) vapors during percutaneous vertebroplasty for the interventional radiologist and the other operating room staff. MATERIALS AND METHODS: During percutaneous vertebroplasty, a polymethyl methacrylate (PMMA) mixture (about 20 mL) was prepared with a mixing system in a normally ventilated room. Atmospheric concentrations of MMA vapors were measured by a gas absorbent badge for individual exposure (GABIE) passive sampler attached to the surgical gowns of the interventional radiologist and the other operating room staff over a period of 460 min. Active sampling was performed over 15 min with an individual pump placed near the breathing zone of the radiologist. MMA vapor concentrations were then measured using gas chromatography and activated charcoal tubes. RESULTS: Mean MMA vapor concentrations measured by the GABIEs over the period of 460 min were 0.51 parts per million (ppm) for the radiologist and 0.22 ppm for the other operating room staff. The emission peaks measured by using charcoal tubes over 15 min were 3.7 ppm. CONCLUSION: MMA vapor concentrations during percutaneous vertebroplasty were well below the recommended maximum exposure of 100 ppm over the course of an 8-h workday.
No preview · Article · Mar 2012 · Skeletal Radiology
[Show abstract][Hide abstract] ABSTRACT: The primary objective of this study conducted on 100 patients is to demonstrate that performing CT-guided percutaneous discectomy for herniated disks results in a significant improvement in pain symptoms at several times (D1, D2, D7, 1 month, 3 months, 6 months). This objective assesses the effectiveness and feasibility of this technique under CT guidance in patients presenting documented lower back pain related to disk herniation that has not improved with appropriate medical treatment. The impact of various factors on the effectiveness of discectomy will also be evaluated. At 1 week, we notes a decrease in average VAS respectively of 71% and 67% in patients treated for posterolateral and foraminal herniated disks; the result for posteromedian herniated disks is only 45% in average decrease. At 6 months post op, 79% of lateralized herniated disks have a satisfactory result (≥ 70% decrease in pain as compared to initial pain), whereas post median herniated disks had a satisfactory result in only 50% of cases. Percutaneous fine needle discectomy probe under combined CT and fluoroscopic guidance is a minimally invasive spine surgery which should be considered as an alternative to surgery. This technique presents several advantages: the small diameter of the probe used (maximum 16 G or 1.5mm) allows a cutaneous incision of only a few millimeters, and a trans-canal approach can be possible; it also decreases the risk of ligamentary lesion and does not cause an osseous lesion of the posterior arc or of the adjacent muscular structures.
No preview · Article · Mar 2011 · European journal of radiology
[Show abstract][Hide abstract] ABSTRACT: We report on a new minimally invasive technique for the vertebral pedicle fracture after placement of a prosthetic disc. This intervention is an adaptation of CT-guided sacroiliac and acetabular fracture screw fixation. This type of procedure enables the perfect placement and measurement of the screw, as well as an extremely small incision under local anesthesia. CT guided Transpedicular fixation could be a useful strategy in the treatment of future cases involving poorly healing pedicle fractures causing persistent symptoms. This intervention confirms the range of capacities of CT scan-controlled interventions in terms of precision, safety, speed, minimal invasiveness, rapid return to everyday activity and consequently, economical management.
No preview · Article · Feb 2011 · European journal of radiology
[Show abstract][Hide abstract] ABSTRACT: The goal of this study was to evaluate the radiation received by the practitioner when performing percutaneous vertebroplasty guided by CT and fluoroscopy for specific anatomical sites: orbits, hands, ankles, and thorax (under lead-lined apron).
Twenty-four vertebroplasties were performed on 18 patients.
The anatomical site that was most exposed to radiation was the right hand (0.37 mSv on average). This study demonstrates a significant correlation between the irradiation dose and fluoroscopy duration, reflecting both the quantity of primary-beam radiation and backscattered radiation. The right hand (P = 0.03), left hand (P = 0.02), and the left orbit (P < 0.0001) are the anatomical zones that are the most affected by the combination of these two types of radiation, with cumulative irradiation doses of 0.45, 0.2, and 0.14 mSv, respectively. There was a significant correlation between the patient weight and radiation of the left hand (P = 0.03), the left orbit (P = 0.03), and the thorax (P = 0.02), confirming the major influence of backscattered radiation.
The most irradiated anatomical sites limiting the number of interventions are the left orbit and the right hand.
No preview · Article · May 2010 · Skeletal Radiology
[Show abstract][Hide abstract] ABSTRACT: Secondary to the progress in interventional imaging, new therapeutic options have been developed that decrease potential complications because they are minimally invasive and they decrease patient rehabilitation time. As a diagnostic modality, computed axial tomography (CAT) allows precise evaluation of the degree of sacroiliac reduction that must be performed. Moreover, the use of CAT enables easy positioning of screws across the sacroiliac joint, thus avoiding nerve and vascular damage. We report our clinical experience of 20 patients treated by CAT-guided percutaneous fixation for posttraumatic unilateral sacroiliac disruption, including evaluation of our technique, its safety, and patient outcomes and long-term results. All patients in this study had successful outcomes, which were judged according to how much pain they experienced and how quickly they resumed normal activity after the procedure. Twelve of 16 patients were able to return to work by postoperative month 2. One patient had degenerative sacroiliac joint syndrome (5%), which was confirmed 6 months after surgery by CAT scan. None of the patients showed radiologic or clinical evidence of instability of the sacroiliac joint or screw migration. Postoperative follow-up, performed at 1, 2, and 3 years in our rehabilitation department, showed stable results over time. All pain disappeared, without the need for medication, in 19 patients (95%).
No preview · Article · Jul 2009 · CardioVascular and Interventional Radiology
[Show abstract][Hide abstract] ABSTRACT: PURPOSE/AIM
To understand the indications, contraindications, technique, efficacy and limits of percutaneous cementoplasty of extraspinal painful osteolytic malignant lesions.
1. History of cementoplasty 2. Review of indications (mainly extraspinal painful osteolytic malignant lesions: metastases and multiple myeloma) and contraindications 3. Technique: i. Osteoplasty: materials and cement (properties: variable or not polymerization, and volume) ii. Guidance (in our experience, combined CT-fluoroscopy guidance) iii. Sedation (in practically all cases, local anesthesia) 4. Efficacy (rapid and lasting reduction in pain), safety, complications and limits (in relation to other oncologic procedures: e.g., radiofrequency and cryotherapy).
CT- and fluoroscopy-guided percutaneous osteoplasty of extraspinal painful osteolytic malignant lesions is a rapid, effective and safe procedure. This exhibit reviews: 1. Indications and contraindications 2. Technique 3. Efficacy and limits of osteoplasty