Extrapedicular approach of percutaneous vertebroplasty in the treatment of upper and mid-thoracic vertebral compression fracture

Purpose: To evaluate the clinical outcome of the extrapedicular approach of percutaneous vertebroplasty ( PVP) for upper and mid- thoracic vertebral compression fractures in patients. Material and Methods: Extrapedicular vertebroplasty was performed in painful compression fractures at T4 - T8 levels. The assessment criteria were changes over time in visual analog scale ( VAS) and mobility score. We evaluated the volume of cement injected, the size of needle required, and complications. Results: Procedures were performed in 27 patients with a total of 34 affected vertebral bodies. Early ( within a week) and one year later, clinical follow- ups showed that pain intensity had decreased by 50% one day after operation and later by 70 - 80%. Mobility scores of all patients were improved immediately after the procedure. Average volume of polymethylmethacrylate ( PMMA) per vertebral body was 3.8 +/- 1.2 ml. Leakage of PMMA occurred in one vertebral level ( intradiskal space), but did not cause clinical complications. Conclusion: PVP of upper and mid- thoracic spine with an extrapedicular approach is an efficient and safe procedure for treating painful thoracic vertebral compression fracture under a cautious patient selection and meticulous technical procedure.