[Minimally invasive surgical management of a bi-pedicular vertebral compression fracture: a case report]. / Traitement chirurgical mini-invasif d'une fracture vertébrale par compression avec atteinte bi-pédiculaire: rapport de cas.

Vertebral compression fractures represent an important part of daily trauma in spine surgery. Their management is codified thanks to the different classifications available to us. The combination of a compression fracture and bi-pedicular involvement of the same vertebra usually leads to extensive surgical management. The main objective of this case report is to share our experience with a minimally invasive osteosynthesis technique performed on this type of fracture. The patient was 61 years old and fell from a 3.5 m high roof. Clinically, he had no sensory-motor deficit. He presented back pain at 8/10 on a visual analogue scale (VAS). The Computed tomography scan revealed a compression fracture of the 4th lumbar vertebra (L4) type A.3 according to the AO classification. There was also bi-pedicular involvement of L4. He underwent minimally invasive surgical management consisting of a combination of kyphoplasty with percutaneous isolated bilateral intra-pedicular osteosynthesis. We observed a rapid sedation of the pain with a VAS of 2/10 at the first day and 0/10 at 3 months. Bone healing was achieved at 3 months on computed tomography (CT) scan. At 18 months, there was no evidence of secondary displacement of the material. Sagittal and frontal balance was satisfactory. The patient had returned to a clinical state like that prior to the accident. The aim of this case was to propose a less invasive surgical alternative for the management of bi-pedicular vertebral compression fractures. In this case, a combination of kyphoplasty with percutaneous isolated bilateral intra-pedicular osteosynthesis resulted in a rapid recovery after surgery and a return to the pre-accident condition.

Resection of a solitary bone metastasis using preoperative computed tomography (CT)-guided hook wire localization: a case report.

Secondary bone metastasis are a common evolution of many types of cancer. In some instance, it is needed to remove those metastases to improve the prognosis of the patient. Bone metastasis that are invisible and non-palpable during the intervention are difficult to remove while being sure to respect safe resection margins. We present the case of a woman suffering from breast cancer. Despite the treatment of the primitive lesion, she presented a solitary bone metastasis on her iliac crest. The lesion was removed surgically but could not be seen or touched during the procedure due to its location. To be certain to remove this lesion during surgery, while respecting safe resection margins, we performed a pre-operative computed tomography (CT)-guided hook wire localization. Using this method, the anatomopathological examination confirmed the tumoral nature of the lesion and that the resection margins were in a safe zone. This technique frequently used to target soft lesion in cases of breast or lung cancers could therefore be used the same way with solid bone lesion.