Modified percutaneous pediculoplasty for lytic pedicle involvement in multiple myeloma

Pedicular involvement in vertebral lesions poses significant challenges during percutaneous vertebral augmentation, particularly when cortical bone integrity is compromised. This report describes a modified percutaneous pediculoplasty (PPP) technique applied to a patient with L5 pedicle involvement secondary to multiple myeloma. The procedure was performed using a modified technique specifically designed to minimize the risk of cement leakage, which is a major concern in cases with lytic destruction of the pedicle. The technique aims to enhance cement containment despite disrupted cortical boundaries. The modification consists of maintaining the working cannula in a fixed intravertebral position during cement polymerization while performing controlled bone-filler retraction under continuous fluoroscopic monitoring. This case highlights the feasibility and safety of a modified PPP approach in anatomically compromised pedicles, offering a potential alternative in cases where traditional techniques pose a higher risk. Although pediculoplasty itself is not a new technique, this report describes a specific modification aimed at reducing cement leakage risk in cases with absent cortical margins. Further clinical studies are warranted to validate this technique and define its role in broader clinical practice.