A novel computer navigation model guided unilateral percutaneous vertebroplasty for vertebral compression fracture: A case report

Current status and challenges of percutaneous vertebroplasty (PVP)

A narrative review regarding percutaneous vertebroplasty (PVP) for osteoporotic vertebral fracture (OVF) is provided herein, addressing the epidemic of OVF in Japan, the latest response to the criticism of PVP for OVFs, the indications and potential risks of PVP for OVFs, and a future perspective for PVP. Each year in Japan, approximately 32,000 patients aged 55 years or older suffer from chronic low back pain for several months to several years due to a compression fracture. PVP is one of the surgical treatments for an OVF, and it is less invasive compared to the traditional open surgery. PVP is suitable for OVF patients who have difficulty walking as assessed by the modified Yokoyama's activities of daily living (ADL) scoring system, and for patients with Kummell's disease diagnosed by CT and MRI examinations. Serious adverse events related to PVP occur in 1.1-3.3% of the cases, but direct deaths from PVP are extremely rare at less than 1%. Recent studies demonstrated that OVF patients treated with PVP are less likely to die after the treatment than non-surgically treated patients, which conflicts with the Cochran reviews' conclusion not supporting PVP for OVFs. Novel robotic systems and procedure-support devices are being developed, providing a next step toward fully automated PVP procedures.

Accuracy of vertebral puncture in percutaneous vertebroplasty

Purpose

To clarify the accuracy of vertebral puncture of the vertebral tertile area needling (VETERAN) method puncturing the pedicle superimposed on one-third of the width between the lateral vertebral line to the contralateral medial lamina line compared with Cathelin-needle-assisted puncture (CAP) method puncturing using the Cathelin needle as a guide in percutaneous vertebroplasty.

Materials and methods

449 punctures by CAP method and 125 punctures by VETERAN method were enrolled. We compared the puncture accuracy of both methods. We estimated a vertebral estimated tilting ratio (VET-ratio) defined as ratio of the distance between the lateral vertebral line and the contralateral medial laminal line to the distance between the vertebral lateral line and the puncture point measured by computed tomography. We also estimated the procedural items and clinical outcomes.

Results

VETERAN method with 100% of punctures within safe zone (cortical breaches within 2 mm) had significantly higher accuracy than CAP method with 97.8% (p < 0.01) for the 2 mm incremental evaluation. No cases with a VET-ratio of 36% or less had cortical breaches. VETERAN method had shorter operative time per puncture (p < 0.01) and exposure time per puncture (p < 0.05).

Conclusion

VETERAN method reduced the occurrence of the inaccurate puncture, operative times, and exposure times. A VET-ratio with 36% or less is associated with a safe puncture using VETERAN method.

Navigation-guided percutaneous pelvic cementoplasty for metastatic bone pain: A case report

RATIONALE

Percutaneous cementoplasty is a minimally invasive procedure that can provide immediate pain relief and improve range of motion in patients with metastatic bone pain. Conventionally, this procedure is guided by computed tomography (CT). However, to minimize exposure to radiation, we performed percutaneous cementoplasty under the guidance of a navigation system.

PATIENT CONCERNS

A 60-year-old man presented with left hip pain for several months due to bone metastasis in the left ilium.

DIAGNOSES

The patient was diagnosed with lung cancer and multiple bone metastases including ileum.

INTERVENTIONS

The puncture needle was placed under the guidance of a navigation system with pre-procedure CT images, and bone cement was injected into the osteolytic lesion in the left ilium.

OUTCOMES

Bone cement placement was confirmed by post-procedure radiography, and its distribution was satisfactory. The patient's Karnofsky Performance Scale and Brief Pain Inventory scores showed improvement in pain and mobility without complications.

LESSONS

Percutaneous cementoplasty guided by a navigation system is a safer and more effective method with less radiation compared with conventional CT-guided methods.