Kyphoplasty

Fig. 16.1

A patient with persistent pain following L1 fracture that did not respond to conservative management. Extrapedicular kyphoplasty was performed. An extrapedicular approach was undertaken and methyl methacrylate injected into the vertebral body through the inserted cannula (a). The procedure was discontinued when cement was noted to extend into the disk space (arrow, b). The anteroposterior view (c) demonstrates the considerable amount of cement that can be deposited into the vertebral body by the extrapedicular approach. Again noted is some cement extravasation into the disk space

Thoracic

Point of Entry

Demarcate the top of the pedicle on AP fluoroscopy.
Also demarcate the spinous process.
Join the demarcated pedicle points.
The point of entry is at the level of this bipedicular line.
Measure the distance from the spinous process to the pedicle. The skin entry point is approximately 1.5× the spinous-pedicle distance, lateral to the pedicle.
Infiltrate the point of entry with local anesthesia.
When bone is encountered, it may also be infiltrated with local anesthesia through the spinal needle.
The needle course is via the potential space between the rib head, transverse process, and pedicle. To this effect, advance the needle obliquely until the rib head is felt. Follow the posterior wall of the rib and advance the instrument anterior to the transverse process. The trajectory is relatively fixed once between the rib and transverse process and is confirmed on lateral fluoroscopy.