Trebern Hugo, Premat Kévin, Chiaroni Pierre-Marie, Cormier Evelyne, Talbi Atika, Drir Mehdi, Mathout Jugurtha, Allard Julien, Elhorany Mahmoud, Bonaccorsi Raphael, Beth Adrien, Bonnet Baptiste, Chiras Jacques, Clarençon Frédéric, Shotar Eimad
Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
Sorbonne Université, Paris, France.
Eur Radiol. 2025 Jul 11. doi: 10.1007/s00330-025-11769-w.
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.
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.
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.
UTV under fluoroscopic control is a challenging procedure, but it is technically achievable and safe. Procedure optimization is paramount to overcoming anatomical difficulties.
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.
由于多种解剖因素影响透视控制质量并可能增加手术风险，T1和T2节段的上胸椎椎体成形术（UTV）是一项技术挑战。本研究的目的是报告T1 - T2节段UTV的可行性和安全性。
纳入2012年3月至2021年9月在一家三级医疗教学医院接受UTV（T1或T2）的所有患者。排除术后未进行对照CT扫描的患者。回顾性收集以下数据：人口统计学资料、手术指征、椎体成形术节段、骨针位置、手术细节、椎体体积、椎体内骨水泥体积、并发症（CIRSE评分）以及临床随访情况。主要结局为手术技术成功，定义为实现正确的骨针轨迹，避免进入椎管且骨水泥从终板到终板填充，无任何不良事件。
纳入40例患者（19例女性，21例男性，平均年龄65岁[范围18 - 89岁]），共49个椎体，其中31/49（63%）为T1椎体成形术。在49例UTV中，30例（61%）用于治疗各种癌症的骨转移。49例UTV中有39例（79.5%）实现了主要结局即技术成功。80次进针中有73次（91%）报告骨针轨迹满意，82%的病例实现了终板到终板填充。84%的术后对照CT扫描观察到骨水泥渗漏。根据CIRSE分类，未报告不良事件。
透视引导下的UTV是一项具有挑战性的手术，但在技术上是可行且安全的。手术优化对于克服解剖困难至关重要。
问题 本研究旨在报告T1和T2椎体上胸椎椎体成形术（UTV）的可行性和安全性，这是一项具有挑战性且鲜有报道的手术。发现 T1和T2 UTV在透视引导下技术上可行且安全。临床意义 尽管T1和T2 UTV显示技术成功且并发症发生率低，但仍是一项复杂手术。透视引导下UTV的主要限制，即使进行了手术优化，仍是侧位透视控制的质量。
