1. 2016;19;593-601Technical Strategies and Anatomic Considerations for an Extrapedicular Modified Inferior Endplate Access to Thoracic and Lumbar Vertebral Bodies
   Technique
   Scott Burner, BS, Douglas P. Beall, MD, and Blake Parsons, MD.

BACKGROUND: Percutaneous access to the vertebral bodies is commonly done via the transpedicular approach for both diagnoses and treatment of spinal pathology. While this approach is effective in most cases, it is difficult in certain situations such as a patient with obstructing hardware from prior surgery.

OBJECTIVES: To investigate and illustrate an alternative to the typical percutaneous access to the vertebral body via an extrapedicular approach and to determine the complications associated with this approach.

STUDY DESIGN: Description of a novel percutaneous vertebral body access technique developed during cadaver dissection and a report of complication rates in cases that were performed using this technique.

SETTING: Radiology department at a private institution.

METHODS: An effective extrapedicular access technique that could safely and consistently allow the needle tip to be placed in the center of the vertebral body was developed from cadaver dissection observations for the purpose of clinical use. A total of 96 vertebral compression fractures from T5 to L5 were treated via the extrapedicular technique at our institution between July 2008 and August 2012. There were 72 patients between ages 27 and 98 (mean age 73.2 years) who underwent treatment.

RESULTS: Cadaver dissection revealed a relatively avascular and aneural portion of the inferior vertebral body just anterior to the pedicle. A total of 96 vertebral fractures were treated using the extrapedicular technique without any recognized clinical complications from the needle access or the instrumentation.

LIMITATIONS: The trial included a relatively small sample size, representing 7.4 percent of total patients treated at our institution. This was likely the result of a smaller patient population with contraindications to typical transpedicular access.

CONCLUSIONS: The thoracic and lumbar vertebral bodies may be accessed using a percutaneous extrapedicular access technique which represents a relatively avascular and aneural approach to the vertebral body. The technique presented allows access to the vertebral body around existing hardware and can accommodate the placement of large instruments. This technique was not associated with any known complications in our series of patients.

Key words: Vertebral body, spine, extrapedicular, kyphoplasty, vertebroplasty, paraspinal, thoracic, lumbar