Percutaneous vertebroplasty through a transdiscal access route after lumbar transpedicular instrumentation

Transpedicular vertebroplasty is an effective procedure to reduce pain and stabilize osteoporotic vertebral fractures. It is, however, difficult to perform after transpedicular instrumentation because the pedicle screws are in the way. To determine if vertebroplasty can be performed in patients who have previously undergone osteosynthesis pedicle-screw fixation. We postulate that an alternate transdiscal route can be used in cases with instrumentation in order to successfully perform vertebroplasty. We report the case of a 73-year-old male patient presenting with a fresh osteoporotic fracture of L2 and L3 6 weeks after having undergone a dorsal operative stabilization between L3 and L5. Vertebroplasty was performed using a transdiscal descending approach to treat the two adjacent vertebral levels. The patient reported a 50% decrease in pain and was able to walk with a stick at 3 months. At late follow-up at 18 months his walking had further improved and he experienced only sporadic lumbar pain. Vertebroplasty can be performed in patients having previously undergone transpedicular instrumentation. The transdiscal route represents such a new approach.