Vertebral augmentation via the rib approach: Surgical essentials and therapeutic effects

Objective. - The rib approach is a new extrapedicular approach for vertebral augmentation in the thoracic spine. This article discusses the surgical essentials and therapeutic effect. Methods. - Computed tomography (CT) imagings were obtained from 100 subjects to stimulate a ct. 4mm puncture needle via the rib approach to determine the anatomical parameters of the channel and the position of the needle inserted in the vertebral body. Application results for 26 patients with T5-10 lesions were observed, four patients were treated under general anesthesia and 22 were treated under local anesthesia. Results. - The channel diameter was 5.9-7.0 mm. In T5-10, the puncture needle could reach the middle of the midsagittal line of vertebral bodies in the transverse plane and only reached the middle and upper parts of the vertebral body in the sagittal plane. One week after surgery, the visual analog scale (VAS) sores decreased to 2.4 + 0.8, the ODI decreased to 13.4 + 5.9, and the anterior and posterior vertebral body height ratios recovered to 82.2 + 13.7% and 86.3 + 13.2%, respectively (all, P<0.05). No intraspinal cement leakage or nerve injury was noted. Conclusions. - Vertebral augmentation via the rib approach is suitable only for patients with T5-10 lesions located in the middle and upper parts of the vertebral body. The puncture needle should be inclined inward and downward. This method is characterized by simple execution and low risks of intraspinal cement leakage and nerve injury. (C) 2022 Published by Elsevier Masson SAS.