The use of cone beam CT in achieving unipedicular spinal augmentation.

Objective: To assess the feasibility of cone beam CT (CBCT) in achieving unipedicular access during spinal cement augmentation. Methods: A retrospective review of all patients who underwent CBCT-guided unipedicular spinal augmentation procedures between 1 January 2012 and 15 June 2015 was performed. 59 patients (43 females 16 males; mean-age, 74.0 years; range, 52-90 years) underwent unipedicular spinal augmentation in 78 vertebral levels (T5-T9, n=14; T10-L2, n=42; L3-L5, n=22). Degree of crossover in contralateral hemivertebral body, complications and 30-day mortality were recorded. Results: 97% (76/78) of procedures were technically successful. Two procedures failed owing to vertebral sclerosis. For vertebroplasty, all cases (6/6) demonstrated cross-over filling of cement and 50% (3/6) showed cement cross-over >50% of contralateral half of the vertebral body. For kyphoplasty, 13 out of 15 procedures demonstrated balloon and cement crossover >50% of contralateral half of the vertebral body. Two kyphoplasty procedures required the second pedicle after midline cross-over of cement failed. Of the kyphoplasty procedures that were successfully performed with the unipedicular approach, 76.9% (10/13) showed cement cross-over >50% of contralateral half of the vertebral body. For stentoplasty, all cases (55/55) showed midline stent-cement complex cross-over and 78.2% (43/55) exhibited stent-cement complex cross-over >50% of contralateral half of the vertebral body. There was no major complication or mortality. Minor complications included asymptomatic cement extravasation (6.4%, n=5) and self-limiting haematoma (1.3%, n=1). Conclusion: Unipedicular access for spinal augmentation procedures is achieved at a high success rate with the use of CBCT. Advances in knowledge: This article describes the novel use of CBCT to achieve unipedicular spinal augmentation. Unipedicular spinal augmentation has the potential to reduce risk, duration, radiation and cost while achieving similar results.