The use of cone beam CT in achieving unipedicular spinal augmentation

To assess the feasibility of cone beam CT (CBCT) in achieving unipedicular access during spinal cement augmentation. A retrospective review of all patients who underwent CBCT-guided unipedicular spinal augmentation procedures between 1 January 2012 and 15 June 2015 was performed. 59 patients (43 females 16 males; mean-age, 74.0 years; range, 52-90 years) underwent unipedicular spinal augmentation in 78 vertebral levels (T5-T9, n = 14; T10-L2, n = 42; L3-L5, n = 22). Degree of cross-over in contralateral hemivertebral body, complications and 30-day mortality were recorded. 97% (76/78) of procedures were technically successful. Two procedures failed owing to vertebral sclerosis. For vertebroplasty, all cases (6/6) demonstrated cross-over filling of cement and 50% (3/6) showed cement cross-over >50% of contralateral half of the vertebral body. For kyphoplasty, 13 out of 15 procedures demonstrated balloon and cement cross-over >50% of contralateral half of the vertebral body. Two kyphoplasty procedures required the second pedicle after midline cross-over of cement failed. Of the kyphoplasty procedures that were successfully performed with the unipedicular approach, 76.9% (10/13) showed cement cross-over >50% of contralateral half of the vertebral body. For stentoplasty, all cases (55/55) showed midline stent-cement complex cross-over and 78.2% (43/55) exhibited stent-cement complex cross-over >50% of contralateral half of the vertebral body. There was no major complication or mortality. Minor complications included asymptomatic cement extravasation (6.4%, n = 5) and self-limiting haematoma (1.3%, n = 1). Unipedicular access for spinal augmentation procedures is achieved at a high success rate with the use of CBCT. This article describes the novel use of CBCT to achieve unipedicular spinal augmentation. Unipedicular spinal augmentation has the potential to reduce risk, duration, radiation and cost while achieving similar results.