Vertebra-pediculoplasty to Prevent Cement Dislodgment in Coronary Split or Severe Osteoporotic Vertebral Fracture after Cement Augmentation

Background: Although balloon kyphoplasty serves as a minimally invasive surgical technique for patients who are refractory to conservative treatment, cement dislodgment and anterior dislocation have been reported in specific type of fractures and patients with severe osteoporosis. The concept of vertebra-pediculoplasty was introduced as a minimally invasive treatment to prevent the aforementioned complications. Objectives: In this article, we report our method of vertebra-pediculoplasty accomplished with fenestrated pedicle screw augmentation in step-by-step detail. Materials and Methods: The procedure starts with a balloon kyphoplasty which is done through a more convergent trajectory. An additional negative pressure suction tube is utilized during the cement injection stage. In this way, the cement injected from both sides has a better chance to coalesce and unify inside the vertebral body. Before the cement hardens, the fenestrated pedicle screws are applied with the aid of a guidewire. Cement is again injected through the fenestrated pedicle screws to augment the screw–cement interface and fill the rest of the cavities. Results: In our series, no implant failure occurred in any patient. Ten patients had improved to minimal disability. The remaining four patients were classified as having a moderate level of disability. At the latest follow-up, no loss of reduction or dislocation of cement was observed. Conclusions: Vertebra-pediculoplasty is a minimally invasive surgery with a favorable biomechanical structure compared with traditional balloon kyphoplasty in certain types of vertebral fractures. Vertebra-pediculoplasty accomplished with fenestrated pedicle screw augmentation offers the advantages of secure fixation, favorable cement–implant integration, and a rod anchoring point for future spinal fixation.