Unipedicular Kyphoplasty and Targeted Cement Placement for T12 Fracture
AVAmax® vertebral balloon and AVAflex® vertebral augmentation needle
The patient is an active 82-year-old female with a history of osteoporosis. She presents with severe back pain that suddenly developed and has troubled her the past six to eight weeks. The patient felt no radicular pain.
She is undergoing pharmacologic management of osteoporosis and has no other health problems. The patient is a non-smoker.
She exhibited point tenderness to percussion and palpation.
Sagittal lumbar MRI demonstrated acute superior endplate fracture (Fig. 1) of the T12 vertebral body with associated bone swelling.
Acute superior endplate fracture; T12
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- Unipedicular access was achieved under biplanar fluoroscopy and a biopsy performed. The biopsy was benign.
- Kyphoplasty was then performed using the AVAmax system (AVAmax® Advanced Vertebral Augmentation System, CareFusion, Waukegan, IL) vertebral balloon to create a void in the vertebral body, reducing extravasation risk. (Fig. 2A)
- Targeted cement delivery was then performed using an AVAflex® curved needle (AVAmax® Advanced Vertebral Augmentation System, CareFusion, Waukegan, IL). (Fig. 2B)
- Four cubic centimeters of polymethylmethacrylate cement (PMMA) were delivered into the superior endplate fracture lines and the anterior portion of the vertebral body.
The patient tolerated the 20-minute procedure without complication. She reported immediate pain relief.
Post-operative imaging (Fig. 3) demonstrated complete fill of the superior endplate fracture, as well as interdigitation of cement throughout the vertebral body, providing structural support. No cement extravasation was observed.
Surgeon’s Treatment Rationale
CareFusion’s AVAmax system provided a unilateral approach to stabilize the fracture with the balloon and curved needle combination.
The procedure was performed on an outpatient basis at a cost lower than the general cost of traditional kyphoplasty.
During the patient’s 6-month follow-up, she is pain free.
Promotional material provided by CareFusion.
The physician author of this case has been compensated for his illustration by CareFusion.
1500 Waukegan Road
McGaw Park, Il 60085
This case demonstrates the evolution of treating vertebral compression fracture over the years. In the 1980s, vertebroplasty was the only treatment available using dissimilar types of needles to inject bone cement into different parts of the body. In the 1990s, the development of kyphoplasty enabled balloon placement to reduce the fracture from the inside and create a cavity before cement injection.
The AVAmax system combines the benefits of the available devices in the market. First, it allows a unipedicular approach that definitely saves time for pedicle targeting. After access is obtained using the AVAmax system, the surgeon can decide on continuing the procedure using a vertebroplasty or kyphoplasty approach. Finally, the AVAflex curved needle allows targeted cement deposition and leakage avoidance.