A novel computer navigation model guided unilateral percutaneous vertebroplasty for vertebral compression fracture: A case report

Abstract

Rational: Vertebral compression fracture (VCF) is one of the most common diseases in spinal surgery. Traditional percutaneous vertebroplasty (PVP) under fluoroscopy is an effective method to treat vertebral compression fracture. However, there is still a risk of vascular nerve injury and infection caused by inaccurate or repeated puncture. Therefore, the purpose of this paper was to assess the accuracy of unilateral PVP guided by screw view model of navigation (SVMN) for VCF.

Patient concerns: A 59-year-old female patient suffered high falling injury, and with back pain as its main clinical symptom.

Diagnoses: The patient was diagnosed with a L1 VCF.

Interventions: We placed the puncture needle under the guidance of SVMN to reach the ideal position designed before operation, and then injected the bone cement to complete the percutaneous kyphoplasty (PKP).

Outcomes: The operative time was 29.5 minutes, the puncture time was 1 time, the fluoroscopy time was 2.9 minutes, and the bone cement distribution was satisfactory. VAS and ODI scores were significant improved postoperatively. No surgical complications, including neurovascular injury and infection, were observed during 28-month follow up.

Lessons: The SVMN guided percutaneous puncture needle insertion in PKP operation for VCF is an effective and safety technique. Besides, the SVMN has also been a contributor to reduce radiation doses and replace conventional fluoroscopy.

Figure 1

Preoperative X-rays of the lumbar. (A) Anterior-posterior and (B) lateral radiographs showed L1 vertebral compression fractures.

Figure 2

Postoperative X-rays of the lumbar. (A) Frontal and (B) lateral radiographs displayed good dispersion of the bone cement and recovery of the vertebral height.

Figure 3

Puncture needle designing. The length and the best trajectory (green arrow) of puncture needle was determined after image acquisition.

Figure 4

Patient tracker was installed. A patient tracker was fixed on the operating table by the connection of the mechanical arm (red arrow).

Figure 5

Puncture needle registration in navigation. The instrument tracker (red arrow), indicator (yellow arrow), puncture needle (green arrow), and indicator fixed on the puncture needle and connected to the instrument tracker.

Figure 6

Puncture needle insertion. The screw view model (black border) of navigation was selected on the workstation. It is the most appropriate occasion to implant a puncture needle when the image in right lower shows green (white arrow).