Patient-Reported Outcomes and Return to Work after CT-Guided Percutaneous Lumbar Discectomy: A Prospective Study.

PURPOSE: To evaluate the effectiveness of percutaneous lumbar discectomy (PLD) under computed tomography (CT) guidance on pain and functional capacities and to estimate the speed of recovery by assessing the time to return to work. MATERIALS AND METHODS: Patients treated with PLD were prospectively included between December 2019 and April 2021. Data regarding pain, duration of symptoms, analgesia intakes, time of absence from work, and the Oswestry disability index (ODI) were collected. Patients were followed-up during 6 months. Duration of hospitalization and time to return to work were reported. The Fisher test was used to compare nominal variables, the Kruskal-Wallis test to compare ordinal variables, and the Student t test to compare quantitative continuous variables. RESULTS: A total of 87 patients were evaluated (median age, 56 years; interquartile range [IQR], 43-66 years). The median ODI decreased from 44 (IQR, 33-53) to 7 (IQR, 2-17) at 6 months (P < .001). The median visual analog scale score decreased from 8 (IQR, 8-9) to 2 (IQR, 0-3) within 6 months (P < .001). In total, 96.5% of patients were discharged on the day of the procedure, and 3.5% were discharged on the following day. No severe adverse events were reported according to the Society of Interventional Radiology (SIR) classification system. Of the 57 patients previously employed, 50 were able to return to work during the follow-up, with a median time of 8 days (IQR, 0-20 days). CONCLUSIONS: Symptomatic lumbar disc herniation can be successfully treated using PLD, resulting in significant improvement in symptoms and functional capacities and a fast return to work.

Feasibility and Safety of Lateral and Posterolateral Percutaneous Vertebroplasty of Osteolytic C1-C2 Lesions under Computed Tomography Guidance and Local Anesthesia.

PURPOSE: To evaluate the safety and effectiveness of lateral or posterolateral percutaneous vertebroplasty (PVP) of osteolytic C1-C2 lesions performed under computed tomography (CT) guidance and local anesthesia. MATERIALS AND METHODS: A retrospective study of 16 consecutive patients (11 females and 5 males; aged from 24 to 86 years; median age, 65.5 years) who underwent 17 lateral or posterolateral PVP was performed. Pain status was assessed using a visual analog scale (VAS). Patients were evaluated preoperatively as baseline and at 24 hours and 1, 6, and 12 months postoperatively, until death, or until loss to follow-up. The Oswestry Disability Index was used to evaluate the patients' functional disability preoperatively. The adverse events were recorded using the Society of Interventional Radiology (SIR) classification. RESULTS: The technical success was 100% (17/17) for a median Spinal Instability Neoplastic Score of 13.5 (interquartile range [IQR], 6.8, 20.3). Mean clinical follow-up was 10.1 months (range, 6-36 months; median, 19.5 months, IQR, 4, 35 months). Mean VAS score decreased significantly from 7.5 (SD ± 2.1) preoperatively to 1.6 (SD ± 1.5) 24 hours postoperatively, and 1.0 (SD ± 1.1), 1.5 (SD ± 1.0), and 0.5 (SD ± 1.5) at 1, 6, and 12 months, respectively (all P < .001). No severe adverse events were observed, but 3 cases of asymptomatic cement leakage were noted (SIR Grade 1; 17.6% [3/17]). CONCLUSIONS: Lateral and posterolateral PVP performed under CT guidance and local anesthesia is safe and effective to treat symptomatic osteolytic C1-C2 lesions.

Comparison of false starts by saw created on flesh and dry bones; as close as possible to the real conditions of criminal dismemberment.

In most experimental protocols, false starts are produced on dry bones obtained through a maceration process for anthropological analyses, for the sake of reproducibility. Although this allows for controlled experimental conditions, the absence of soft parts when experimentally creating false starts does not correspond to the real conditions of criminal dismemberment. The main objective of this study was to determine if the results of experimental work on the characteristics of false starts were valid under medico-legal conditions. In this experimental study, a hand saw (rip saw, wavy set, TPI 32) was used. 240 false starts were produced on human and pig bones. Randomly, the false starts were either produced on a dry bone or on a flesh bone. The criteria for microscopic analysis included the shape of the walls, the shape and visibility of striae on the floor, the shape of the profile, and the minimum width of the false start. On human bone, 100% of the false starts produced on a bone that had previously undergone a maceration process for anthropological analyses (dry bone) allowed the definition of all the blade characteristics. This was the case for 78.3% on bone in the presence of soft tissue (flesh bone). The striae on the floor of the false start are in some cases less visible with flesh bones, implying that it may be more difficult to conclude on the characteristics of a saw under medico-legal conditions.

Combined vertebroplasty and pedicle screw insertion for vertebral consolidation: feasibility and technical considerations.

PURPOSE: To assess the feasibility and technical accuracy of performing pedicular screw placement combined with vertebroplasty in the radiological setting. METHODS: Patients who underwent combined vertebroplasty and pedicle screw insertion under combined computed tomography and fluoroscopic guidance in 4 interventional radiology centers from 2018 to 2023 were retrospectively assessed. Patient demographics, vertebral lesion type, and procedural data were analyzed. Strict intra-pedicular screw positioning was considered as technical success. Pain score was assessed according to the Visual Analogue Scale before the procedure and in the 1-month follow-up consultation. RESULTS: Fifty-seven patients (38 men and 19 women) with a mean age of 72.8 (SD = 11.4) years underwent a vertebroplasty associated with pedicular screw insertion for the treatment of traumatic fractures (29 patients) and neoplastic disease (28 patients). Screw placement accuracy assessed by post-procedure CT scan was 95.7% (89/93 inserted screws). A total of 93 pedicle screw placements (36 bi-pedicular and 21 unipedicular) in 32 lumbar, 22 thoracic, and 3 cervical levels were analyzed. Mean reported procedure time was 48.8 (SD = 14.7) min and average injected cement volume was 4.4 (SD = 0.9) mL. A mean VAS score decrease of 5 points was observed at 1-month follow-up (7.7, SD = 1.3 versus 2.7, SD = 1.7), p < .001. CONCLUSION: Combining a vertebroplasty and pedicle screw insertion is technically viable in the radiological setting, with a high screw positioning accuracy of 95.7%.

MRI and spondyloarthropathy: diagnostic performance compared to long-term clinical follow-up with evaluation of gadolinium chelates injection.

OBJECTIVES: To evaluate MRI performance on both initial and long-term rheumatologic diagnosis of spondyloarthritis (SpA), taking into account clinical evolution and treatment response, and the impact of gadolinium injection. METHODS: In this single-center study, patients who underwent both spinal and sacroiliac (SI) joint MRI were prospectively recruited between May 2013 and January 2014 and followed for 7 years until 2020. Clinical, biological, and radiologic parameters were collected. At 7-year follow-up (2020), two independent readers reevaluated the initial MRI datasets for specific radiological features of SpA with a 5-point Likert scale to record the estimation of confidence. The centralized MRI interpretations were compared to the established rheumatologic diagnoses in 2013 and 2020. RESULTS: In total, 145 patients (52 men and 93 women) were included. During the 7-year follow-up, the number of patients with positive SpA diagnosis decreased from 93 to 58. Mean sensitivity, specificity, and accuracy of non-contrast MRI were 18, 97, and 49% and 27, 97, and 69% considering 2013 and 2020 rheumatologic diagnoses, respectively. Mean sensitivity, specificity, and accuracy values of gadolinium-enhanced MRI were 26, 97, and 54% and 38, 97, and 73% considering 2013 and 2020 diagnoses, respectively. Post-contrast MRI enabled identification of a subgroup of enthesis-only lesions, without any bone lesions, corresponding to 14% of the pathological cohort. It confirmed uncertain diagnoses in an additional 8.5% of pathological cases. CONCLUSIONS: MRI performance for SpA diagnosis is higher when long-term clinical follow-up is considered than when compared to initial diagnosis. Gadolinium injection increases MRI diagnostic performance and may demonstrate a pure enthesic form of the disease, without bone abnormality. KEY POINTS: • Compared to the rheumatologist's diagnosis over long-term clinical follow-up, MRI performance for SpA is higher than usually estimated. • Gadolinium injection increases diagnostic performance of MRI as it may identify a purely enthesis form of the disease. • Gadolinium injection should be discussed in patients for whom the diagnostic suspicion is strong and whose initial non-injected examination is normal or doubtful.

Clinical and radiological outcomes following insertion of a novel removable percutaneous interspinous process spacer: an initial experience.

PURPOSE: To evaluate clinical and radiological outcomes of a series of patients treated with a removable percutaneous interspinous process spacer (IPS) (LobsterProject® Techlamed®) for symptomatic degenerative lumbar spinal stenosis (DLSS). METHODS: All patients treated in two centres with this IPS during 2019 were retrospectively reviewed. Procedures were performed under deep sedation or general anaesthesia by two interventional radiologists. Patients were clinically evaluated before intervention and at 3-month follow-up with Visual Analog Scales for pain (VAS), Oswestry Disability Index (ODI) and radiologically with MRI or CT scans. Neural foramina were independently measured for each patient on pre- and post-procedural CT scans by two radiologists. RESULTS: Fifty-nine patients were treated in the selected period of which fifty-eight had complete documentation (mean age 71.2 ± 9.2 years [55-92], 32 males, 26 females). Forty-eight interventions were performed under deep sedation and ten under general anaesthesia, without procedural complications. Clinical follow-up at 3 months showed a significant reduction of pain (VAS from 83 ± 9 to 29 ± 19, - 65%; p < 0.001) and an improvement in functional outcomes (ODI from 31 ± 12 to 13 ± 10%, - 58%; p < 0.001). There was one case of unsatisfactory positioning post procedure, two cases of posterior migration at 3-month follow-up and one case of spinous process fracture. Mean neural foramina area increased from 77 ± 23 to 95 ± 27 mm2 (+ 26%; p < 0.001) with very good inter-observer reliability (Cronbach's alpha = 0.899). CONCLUSION: Percutaneous minimally invasive insertion of a removable IPS device demonstrates a favourable safety profile, good clinical outcomes at 3 months, and apparent anatomical increase in foraminal dimensions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05203666-Release Date: 21st January 2022, retrospectively registered.

Trans-isthmic pars interarticularis screw fixation under CT and fluoroscopic guidance: technical success and clinical outcome in patients with symptomatic low-grade lumbar isthmic lysis.

OBJECTIVES: To assess the technical success of trans-isthmic screw fixation with simultaneous CT and fluoroscopic guidance in patients with symptomatic low-grade isthmic spondylolisthesis. METHODS: Fifty patients (28 women and 22 men; mean age ± standard deviation: 50 years ± 18.9) presenting with symptomatic low back pain with isthmic spondylolisthesis refractory to medical management were treated by means of trans-isthmic pars interarticularis percutaneous screw fixation. The procedure was performed under local anesthesia with double CT and fluoroscopic guidance. Primary outcome was technical success of the procedure, which was assessed with a post-procedure CT using the same success criteria as surgical screw placement with regard to entry point, trajectory, and screw tip. Secondary outcome was pain decrease assessed by the Visual Analog Scale (VAS). RESULTS: Ninety-nine procedures were performed in 50 patients and 99 screws were inserted. Postoperative CT assessment showed satisfactory screw placement in 96 cases, reflecting a technical success rate of 96.9%. No complications occurred during or after the procedure. Pain assessment showed a pain decrease of VAS score from a median of 7 (min 5, max 10; MAD 1.4) to 2 (p < 0.0001) (min 0, max 7, MAD 1.7) with a mean follow-up of 39 months. CONCLUSION: Trans-isthmic screw fixation performed under CT and fluoroscopic guidance presents a high technical success and appears as a safe procedure and effective procedure in patients with symptomatic low-grade isthmic lysis. KEY POINTS: • Trans-isthmic pars interarticularis percutaneous screw insertion is feasible under double CT and fluoroscopic guidance by a radiologist with a high technical success. • This technique can be performed under local anesthesia only. • In patients with chronic low back pain, isthmic screwing allows long-term pain improvement.

Percutaneous discectomy under CT and fluoroscopy guidance: an international multicentric study.

PURPOSE: To evaluate the technical efficacy, safety, and reproducibility of automated percutaneous lumbar discectomy (APLD) under CT and fluoroscopic guidance, for treating radiculopathy caused by lumbar disc herniation in patients impervious to conservative treatment. METHODS: A total of 77 patients with symptomatic lumbar disc herniation were treated with APLD in a prospective multicentric study performed in four centers across three countries. Magnetic resonance imaging and/or computed tomography was used to evaluate the disc herniation before and after the procedure. Only local anesthesia was used during these procedures. Clinical outcomes were measured with the visual analog scale (VAS) for pain at one and 6 months after the procedure. RESULTS: Technical success rate was 100% with a mean intervention duration of 30 min (15-45 min). No complications occurred during the procedure. Post-lumbar puncture syndrome occurred in three patients who were successfully treated with blood patches. VAS decreased from a mean of 8 before the intervention to 3 1 month after (p value = 0.001). The requirement for analgesia decreased from 100 to 27%. No statistically significant differences in outcomes were found between the centers. CONCLUSION: APLD with dual imaging guidance under local anesthesia is a safe, feasible, and reproducible technique to treat symptomatic lumbar disc herniation.

CT-guided fixation of pelvic fractures after high-energy trauma, by interventional radiologists: technical and clinical outcome.

OBJECTIVE: The aim of our study was to evaluate screw placement accuracy, safety, complications, and clinical outcomes including functional and pain score, in 32 patients treated with CT-guided pelvic ring fixation after high-energy trauma. MATERIALS AND METHODS: Consecutive patients who were treated by CT-guided fixation of sacral or acetabular fractures after high-energy trauma were included. All procedures were performed under general anesthesia, with dual CT and fluoroscopic guidance, by interventional radiologists. Fractures were minimally displaced or reduced unstable posterior pelvic ring disruptions, with or without sacroiliac disjunction (Tile B or C) and minimally displaced acetabular fractures. The primary outcome evaluated was screw accuracy. Secondary outcomes included patient radiation exposure, duration of the procedure, complications, clinical functional score (Majeed score), and pain scale (VAS, visual analog scale) evaluation during a follow-up period from 4 to 30 months postoperatively. RESULTS: Thirty-two patients were included (mean age 46) and 62 screws were inserted. Screw placement was correct in 90.3% of patients (95% of screws). Mean procedure duration was 67 min and mean patient radiation exposure was 965 mGy cm. Mean follow-up was 13 months and no complications were observed. The mean Majeed score at final follow-up was 84/100 and the mean VAS was 1.6/10. CONCLUSION: This technique is an effective and safe procedure in specific cases of pelvic ring and acetabulum fractures. It allows accurate screw placement in a minimally invasive manner, leading to effective management of poly-traumatized patients. KEY POINTS: • CT-guided pelvic ring fixation, including sacroiliac and acetabular fractures, is an effective and safe procedure. • It allows accurate and minimally invasive screw placement, leading to effective management of poly-traumatized patients. • Multidisciplinary cooperation is essential to ensure efficiency and safety.

An unusual Staphylococcus saccharolyticus spondylodiscitis post kyphoplasty: a case report.

BACKGROUND: Staphylococcus saccharolyticus is a rarely encountered coagulase-negative, which grows slowly and its strictly anaerobic staphylococcus from the skin. It is usually considered a contaminant, but some rare reports have described deep-seated infections. Virulence factors remain poorly known, although, genomic analysis highlights pathogenic potential. CASE PRESENTATION: We report a case of Staphylococcus saccharolyticus spondylodiscitis that followed kyphoplasty, a procedure associated with a low rate but possible severe infectious complication (0.46%), and have reviewed the literature. This case specifically stresses the risk of healthcare-associated S. saccharolyticus infection in high-risk patients (those with a history of alcoholism and heavy smoking). CONCLUSION: S. saccharolyticus infection is difficult to diagnose due to microbiological characteristics of this bacterium; it requires timely treatment, and improved infection control procedure should be encouraged for high-risk patients.

Symptomatic Schmorl's nodes: role of percutaneous vertebroplasty. Open study on 52 patients.

PURPOSE: To assess the feasibility and clinical outcome of combined CT and fluoroscopy-guided percutaneous vertebroplasty in the management of painful Schmorl's nodes (SN). METHODS: A prospective study was carried out from January 2014 to January 2016 in 52 consecutive patients. Thirty-two men and 30 women aged between 42 and 88 years old were consecutively included. Technical success was defined as the ability to deposit cement in the subchondral endplate anteriorly, around the SN and posteriorly to the SN, in a cupule-like shape. Data regarding procedure time, amount of cement injection, and cement leakage were also noted. Assessment of pain was performed with VAS score and Oswestry disability index. All patients underwent a clinical and radiological follow-up at 1 day, 1 month, 6 months, and 1 year after procedure. RESULTS: Technical success was 100%. Mean procedural time was 15 min, and mean injected cement volume was 2.8 mL. The VAS and Oswestry disability index decreased respectively from 7.2 ± 1.5 to 2.1 ± 1.0 and from 59.2 ± 16.2 to 17.1 ± 5.0 at 1 month. Follow-up mean VAS scores were 2.4 (± 1.4) at 6 months and 2.2 (± 1.2) at 12 months. CONCLUSION: PVP appears as a feasible procedure in patients with painful SN with satisfying pain decrease in the following year after procedure.

Ultrasound-guided percutaneous release of the carpal tunnel: comparison of the learning curves of a senior versus a junior operator. A cadaveric study.

OBJECTIVE: The purpose was to evaluate, in a cadaveric cohort, the feasibility and the learning curve of ultrasound-guided percutaneous carpal tunnel release. MATERIALS AND METHODS: Fourteen carpal tunnel releases were carried out on unembalmed cadavers by a senior and a junior radiologist. Procedures were realized with an 18-MHz linear probe. An anatomical evaluation was first performed using ultrasound to detect any anatomical variant. After hydrodissection of the carpal tunnel with lidocaine, a 3-mm hook knife was introduced into the security zone to perform a retrograde section of the transverse carpal ligament (TCL) under ultrasound guidance. Anatomical dissection was performed for each wrist. The main evaluation criterion was the complete TCL section. The procedure duration (minutes), skin incision size (millimeters), the integrity of the median nerve, thenar motor branch, and palmar vascular arch were also evaluated. RESULTS: The senior operator was able to perform a complete release after training on three specimens and the junior operator after four specimens (p > 0.05). In most of the cases when complete release was not achieved, it was due to an incomplete section of the distal TCL (10 mm missing section on average). Mean duration time of procedure was 14 min (11 min for the senior versus 17 min for the junior, p > 0.05). Damage of neither the median nerve nor the vascular structure was observed. Mean size of the skin incision was 3 mm. CONCLUSION: The ultrasound-guided percutaneous release of the carpal tunnel is demonstrated to be a procedure with a rapid learning curve.

Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture.

Background and objectives: Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients' quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. Materials and Methods: A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Results: Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Conclusions: Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.

Percutaneous vertebroplasty under local anaesthesia: feasibility regarding patients' experience.

OBJECTIVE: Evaluate patients' intraoperative experience of percutaneous vertebroplasty (PV) performed without general anaesthesia in order to assess the feasibility of local anaesthesia and simple analgesic medication as pain control protocol. METHODS: Ninety-five patients who underwent single-site PV were consecutively included in the study between 2011 and 2013. Each procedure was achieved under local anaesthesia and perfusion of paracetamol, tramadol and dolasetron, with combined CT and fluoroscopy guidance. Numeric pain scale (NPS) was collected before, during and after intervention. After intervention, patients were asked to evaluate their experience as "very bad", "bad", "fair", "good" or "very good", independently of the pain. RESULTS: Indications for vertebroplasty were osteopenic fractures (78 %), aggressive angiomas (13 %) and somatic tumours (9 %). In 76 % of cases, patients' experience was described as "very good" (44 %) or "good" (32 %), whereas 19 % described it as "fair" and 5 % as "very bad". Mean operative NPS was 5.5. After intervention, NPS was significantly lower with a decrease of 4.5 points. No differences were found according to the localization, type of lesion, age or sex either in terms of experience or NPS. CONCLUSION: Percutaneous vertebroplasty is feasible under local anaesthesia alone, with a very good or good experience in 76 % of the patients. KEY POINTS: • Vertebroplasty is a first-line therapy for consolidation and pain control of vertebral lesions. • This procedure is commonly performed under general anaesthesia or conscious sedation. • We perform vertebroplasty under local anaesthesia and simple analgesic protocol with acceptable experience. • Percutaneous vertebroplasty can safely be proposed in a fragile population.

Percutaneous low-pressure bone stenting to control cement deposition in extensive lytic lesions.

OBJECTIVE: To evaluate low-pressure bone stenting combined with cementoplasty in extensive lytic lesions. METHODS: A single-centre study involving four consecutive patients (four women) with extensive lytic tumours was performed. The average age was 65 years. Surgical treatment was not indicated or not wished for by the patients. Institutional review board approval and informed consent were obtained. Percutaneous consolidation was performed by an interventional radiologist under fluoroscopy guidance. Follow-up was assessed using the visual analogue scale (VAS). RESULTS: Under general (n = 2) or local (n = 2) anaesthesia, five 11-gauge bone biopsy needles were advanced in four lesions. Five auto-expandable uncovered stents (10-14 mm diameter and 40-60 mm long) were inserted. In all cases, bone cement was successfully placed into the tumours. The volume of cement that was injected through the cannulas into the stents was 5-10 mL. Using VAS, pain decreased from more than 9/10 preoperatively to less than 2/10 after the procedure for all patients (p < 0.05). No complications occurred during the follow-up (8-19 months). CONCLUSION: This study suggests that cementoplasty combined with low-pressure bone stenting could allow effective bone stabilization resulting in pain relief. KEY POINTS: • Low-pressure bone stenting is possible. • This technique improves cement injection control. • The procedure allows effective bone stabilization resulting in pain relief.

Percutaneous consolidation of loosened spine arthrodesis under CT and fluoroscopy guidance by radiologists: a new useful technique.

OBJECTIVE: The objective was to evaluate percutaneous computed tomography (CT) and fluoroscopy-guided injection of bone cement for consolidation of loosened posterior arthrodesis performed by radiologists. METHODS: A single-centre prospective study involving four consecutive patients (three women, one man) suffering from screw loosening (three at the vertebral level, one at the iliac wing level) after Posterior Lumbar Interbody Fusion (PLIF) treatment was done. The average age was 80 years. Surgical treatment was not indicated or not wished for by the patients. Institutional review board approval and informed consent were obtained. Percutaneous consolidation was performed by an interventional radiologist under CT and fluoroscopy guidance. The path of the trocars was made outside loosened screws bilaterally. Follow-up was assessed using the Visual Analog Scale (VAS). RESULTS: In all cases, bone cement was successfully placed around the loosened screw. The mean volume of cement that was injected was 3 ml. No cement leakage was observed. No neurological complication occurred. Using VAS, pain decreased from more than 9/10 preoperatively to less than 2/10 the day after the procedure for all patients (p < 0.05). CONCLUSION: This study suggests that loosening of spine arthrodesis could be successfully treated by percutaneous injection of bone cement under CT and fluoroscopy guidance. KEY POINTS: • PLIF is one of the surgical techniques for spinal arthrodesis. • Treatment indications are degenerative disease or instability following trauma, tumour, or infection. • Screw loosening is a frequent complication that can occur after surgery. • Percutaneous facet consolidation under dual guidance seems to be a feasible technique. • The procedure is performed under local anaesthesia using a minimally invasive approach.

Stabilisation of a loosened femoral gamma nail by percutaneous cement injection (cementoplasty): a new technique.

Surgical repair of pertrochanteric and subtrochanteric fractures in the elderly is usually achieved using an endomedullary nail. Unfortunately, even today, some of the patients who undergo this intervention develop periprosthetic bone absorption over time that can lead to loosening of the prosthesis, resulting in pain, joint instability and the need for revision surgery. Surgical revision is hindered by potential complications related to patients' existing underlying medical conditions. It is often the case that these patients are weak and present comorbidities, which can lead to an absolute contraindication to surgery. An interesting alternative could be the stabilisation by percutaneous injection of cement (cementoplasty) in the periprosthetic space under CT and fluoroscopic guidance. In patients with absolute contraindication we performed percutaneous cementoplasty as treatment for femoral prosthesis loosening. Our procedure was technically a success following the end of the intervention period (follow-up: 6 months). The patient no longer experienced significant pain and showed stability of the prosthesis, as demonstrated by CT.

CT scan-guided percutaneous osteosynthesis of a complex, multifocal fracture of the pelvic girdle in a 14-year-old adolescent.

We report on a 14-year-old girl with minimally displaced pelvic girdle and acetabular roof fracture following motor vehicle trauma, treated percutaneously under CT and C-arm fluoroscopic guidance by an interventional radiologist. After informed consent from the patient's parents, under surgical aseptic conditions and under general anesthesia, three screws were positioned adequately under dual guidance by a radiologist and without immediate or long-term complication. The patient was mobilized 48 h after the procedure and resumed normal activities after 1 month. Even though the technique has been described before on adults, to our knowledge this is the first time it has been described on a pediatric patient.

Percutaneous facet screw fixation of lumbar spine with CT and fluoroscopic guidance: a feasibility study.

PURPOSE: To assess the feasibility of computed tomography (CT)- and fluoroscopy-guided percutaneous facet screw fixation following anterior lumbar interbody fusion (ALIF) or anterior pseudarthrosis in adults. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained for this study. One hundred seven consecutive adult patients (46 men, 61 women; mean age ± standard deviation: 56.3 years ± 12.9) with ALIF (n = 79) or anterior pseudarthrosis (n = 28) were prospectively treated by means of percutaneous facet screw fixation with CT and fluoroscopic guidance. Two 4.0-mm cannulated screws were placed per level to fix facet joints by using either a translaminar facet or transfacet pedicle pathway. Only local anesthesia was used during these procedures. Procedural time was noted for each patient. Postoperative follow-up ranging from 1 year to 3 years was assessed by using Macnab and radiologic criteria. RESULTS: The mean procedure times for a lumbar single-level and a double-level fusion ranged from 15 to 25 minutes and from 40 to 50 minutes, respectively. All the transfacet pedicle (n = 182) and translaminar facet (n = 56) screws were successfully placed in one attempt. Radiographic fusion was observed within the year following posterior fixation in all patients despite one translaminar screw failure. According to the Macnab criteria, the clinical results were classified as excellent in 92 (86%) and good in 15 (14%) of 107 patients at the time of their last follow-up examination. CONCLUSION: This feasibility study showed that CT- and fluoroscopy-guided percutaneous facet screw fixation is a rapid, safe, and effective method.