Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland.
Department of Interventional and Diagnostic Neuroradiology, Inselspital University Hospital of Bern, Bern, Switzerland.
J Neurointerv Surg. 2019 Jun;11(6):603-609. doi: 10.1136/neurintsurg-2018-014481. Epub 2018 Dec 14.
To describe a new technique to obtain minimally invasive but efficient vertebral body (VB) reconstruction, augmentation, and stabilization in severe osteoporotic and neoplastic fractures, combining two pre-existing procedures. The implant of vertebral body stents (VBS) is followed by insertion of percutaneous, fenestrated, cement-augmented pedicular screws that act as anchors to the posterior elements for the cement/stent complex. The screws reduce the risk of stent mobilization in a non-intact VB cortical shell and bridge middle column and pedicular fractures. This procedure results in a 360° non-fusion form of vertebral internal fixation that may empower vertebral augmentation and potentially avoid corpectomy in challenging fractures.
This report provides step-by-step procedural details, rationale, and proposed indications for this procedure. The procedure is entirely percutaneous under fluoroscopic guidance. Through transpedicular trocars the VBS are inserted, balloon-expanded and implanted in the VB. Over k-wire exchange the transpedicular screws are inserted inside the lumen of the stents and cement is injected through the screws to augment the stents and fuse the screws to the stents.
This technique may find appropriate applications for the most severe osteoporotic fractures with large clefts, high-degree fragmentation and collapse, middle column and pedicular involvement, and in extensive neoplastic lytic lesions.
Stent-Screw-Assisted Internal Fixation (SAIF) might represent a minimally invasive option to obtain VB reconstruction and restoration of axial load capability in severe osteoporotic and neoplastic fractures, potentially obviating the need for more invasive surgical interventions in situations that would pose significant challenges to standard vertebroplasty or balloon kyphoplasty.
描述一种新的技术，以获得微创但有效的椎体（VB）重建、增强和稳定，在严重的骨质疏松性和肿瘤性骨折中，结合两种现有的手术。椎体支架（VBS）的植入物随后插入经皮、有孔、水泥增强的椎弓根螺钉，作为后柱的锚点，用于水泥/支架复合物。螺钉可减少非完整 VB 皮质壳内支架移动的风险，并桥接中间柱和椎弓根骨折。该手术导致一种 360°非融合形式的椎体内固定，可能增强椎体增强，并有可能避免在具有挑战性的骨折中进行椎体切除术。
本报告提供了该手术的分步手术细节、原理和建议的适应证。该手术完全在透视引导下经皮进行。通过椎弓根套管插入 VBS，球囊扩张并植入 VB。通过更换 K 线，将椎弓根螺钉插入支架的管腔内部，并通过螺钉注入水泥，以增强支架并将螺钉融合到支架上。
该技术可能适用于最严重的骨质疏松性骨折，包括大裂缝、高度碎裂和塌陷、中间柱和椎弓根受累以及广泛的肿瘤性溶骨性病变。
支架-螺钉辅助内固定（SAIF）可能是一种微创选择，可获得严重骨质疏松性和肿瘤性骨折的 VB 重建和轴向负荷能力的恢复，潜在地避免了在对标准椎体成形术或球囊后凸成形术构成重大挑战的情况下，需要更具侵袭性的手术干预。
