Technical strategies and anatomic considerations for parapedicular access to thoracic and lumbar vertebral bodies

Objectives To investigate and illustrate a variation on the traditional percutaneous access to the vertebral body via a parapedicular approach. Design An effective parapedicular access technique that could safely and reliably guide the needle tip into the center of the vertebral body was developed from cadaver dissection observations for the purpose of clinical use. Patients A total of 102 vertebral compression fractures from T-4 to L-5 were treated via the parapedicular access at our institution between July 2005 and March 2006. There were 72 patients between the ages of 17 and 96 years (mean age: 68.2 years) who underwent treatment. Results The cadaver dissection revealed a relatively avascular and aneural portion of the vertebral body along the superior margin of the vertebral body-pedicle junction. A total 102 vertebral fractures were treated using the parapedicular access technique without any recognized clinical complications from the needle access or the instrumentation. Conclusions The thoracic and lumbar vertebral bodies may be safely, reliably, and reproducibly accessed using a percutaneous parapedicular access technique. The technique presented represents a relatively avascular and aneural approach to vertebral body.