Upper thoracic T1 and T2 percutaneous vertebroplasty: a review of 10 years of experience.

OBJECTIVE

T1 and T2 upper thoracic vertebroplasties (UTVs) represent a technical challenge due to various anatomical factors that impact the quality of fluoroscopic control and potentially increase procedural risks. The aim of this study is to report the feasibility and safety of T1-T2 UTV.

MATERIALS AND METHOD

All patients having undergone UTV (T1 or T2) from March 2012 to September 2021 in a single tertiary care teaching hospital were included. Patients without a post-procedure control CT scan were excluded. The following data were retrospectively collected: demographics, procedure indications, vertebroplasty level(s), bone needle position, procedure details, vertebral body volume, intracorporeal cement volume, complications (CIRSE score), and clinical follow-up. The primary outcome was procedural technical success, defined as achieving both a correct bone-needle trajectory avoiding the spinal canal and endplate-to-endplate cement filling, without any adverse events.

RESULTS

Forty patients (19 females, 21 males, average age 65 years [range 18-89]) were included, totaling 49 vertebrae with 31/49 (63%) T1 vertebroplasties. Of the 49 UTVs, 30 (61%) were performed to treat bone metastases from various cancers. The primary outcome, technical success, was achieved in 39/49 (79.5%) of the UTVs. Satisfactory bone needle trajectory was reported in 73/80 (91%) of the approaches, and endplate-to-endplate filling was achieved in 82% of cases. Cement leakage was observed on 84% of the post-operative control CT scans. Based on the CIRSE classification, no adverse events were reported.

CONCLUSION

UTV under fluoroscopic control is a challenging procedure, but it is technically achievable and safe. Procedure optimization is paramount to overcoming anatomical difficulties.

KEY POINTS

Question This study aims to report the feasibility and safety of upper thoracic vertebroplasty (UTV) of T1 and T2 vertebrae, a challenging procedure, seldom reported. Findings T1 and T2 UTV is technically feasible and safe under fluoroscopic guidance. Clinical relevance T1 and T2 UTV remains a complex procedure despite demonstrating technical success and a low complication rate. The main limit to fluoroscopy-guided UTV, even with procedure optimization, is the quality of lateral-projection fluoroscopic control.