There was an alarming amount of fracture at this level and the cement was maintained posterior to the anterior border of the vertebral body and anterior to the posterior border of the vertebral body. Approximately 4 mL of cement was introduced from the right side and approximately 1.5 mL of cement was introduced from the left side. The balloons were then deflated and removed and cement was introduced in a semi-liquid state, first on the right side, and then on the left side. We did this then on the left side as well. We inflated the balloon to approximately 2 mL maintaining the pressure and to ensure that we remained within the confines of the vertebral body with the balloon inflation. We then inserted the cannulas for the kyphoplasty system bilaterally and obtained transpedicular biopsies, which were sent for histopathology.Īt this point, we inserted the balloon on the patient’s right side and inflated it with contrast up to approximately 380 mmHg and this was checked constantly under both AP and lateral fluoroscopy simultaneously. At this point, we confirmed the level of the T6 vertebral body and started our open kyphoplasty.įirst we inserted the Jamshidi needles under fluoroscopy through the pedicles to the vertebral body. We employed fluoroscopy once again to check our level of operation and extended our incision slightly in the cephalad direction. Using the NuVasive Maxcess retractor system, we held the muscle and skin edges apart. We marked a midline incision with an indelible marker and then used a #10 blade to incise the skin down to the level of the subcutaneous fat.Īt this point, we used Bovie cautery to complete our dissection exposing the T5 through T7 lamina and we kept all the posterior elements intact. A time-out was called and preoperative antibiotics were dosed. The patient’s thoracic region was prepped and draped in the usual sterile fashion after using fluoroscopy to identify the level of operation. He was secured onto an open bottom Jackson table and all of his pressure points were padded appropriately. A foley catheter was inserted and the patient was turned prone after neuromonitoring electrodes were attached. PROCEDURE IN DETAIL: The patient was identified in the preoperative holding area and then brought back to the operating room where he was induced under general anesthesia and intubated.
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