Thoracolumbar vertebroplasty using the spinal navigation system for the nonunion after osteoporotic compression fracture

Objective: To document surgical technique and usefulness of computer image-guided transpedicular augmentation for the thoracolumbar vertebral nonunion after osteoporotic compression fracture by calcium phosphate cement (CPC). Design: A clinical study. Materials and Methods: After exposure of posterior lamina, image-guided reference frame was fixed to the applicable thoracolumbar spinous process. A transpedicular bore was then hemilateraly formed under the image of the computer-assisted navigation system. An injectable, biodegradable CPC was poured through the transpedicular bore. In three cases of four, posterior spinal instrumentation was added to keep the alignment and stability. Results: The surgery was performed safely with computer assistance. The accurate bore was made through the pedicle. The navigation error was 0.52 mm, on average. The bone substitute was packed into the compressed vertebra though the small transpedicular bore. All four patients showed an improvement in their symptoms after operation. Conclusion: This computer image-guided procedure would aid surgeons in the complete and safe approach to perform the transpedicular augmentation for the compressed thoracolumbar vertebrae.