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Original research
Stent-screw-assisted internal fixation: the SAIF technique to augment severe osteoporotic and neoplastic vertebral body fractures
  1. Alessandro Cianfoni1,2,
  2. Daniela Distefano1,
  3. Maurizio Isalberti1,
  4. Michael Reinert3,4,
  5. Pietro Scarone4,
  6. Dominique Kuhlen4,
  7. Joshua A Hirsch5,
  8. Giuseppe Bonaldi6
  1. 1 Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
  2. 2 Department of Interventional and Diagnostic Neuroradiology, Inselspital University Hospital of Bern, Bern, Switzerland
  3. 3 Department of Neurosurgery, Inselspital University Hospital of Bern, Bern, Switzerland
  4. 4 Department of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland
  5. 5 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  6. 6 Department of Neuroradiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
  1. Correspondence to Dr Daniela Distefano, Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano 6900, Switzerland; daniela.distefano{at}eoc.ch

Abstract

Objectives To describe a new technique to obtain minimally invasive but efficient vertebral body (VB) reconstruction, augmentation, and stabilization in severe osteoporotic and neoplastic fractures, combining two pre-existing procedures. The implant of vertebral body stents (VBS) is followed by insertion of percutaneous, fenestrated, cement-augmented pedicular screws that act as anchors to the posterior elements for the cement/stent complex. The screws reduce the risk of stent mobilization in a non-intact VB cortical shell and bridge middle column and pedicular fractures. This procedure results in a 360° non-fusion form of vertebral internal fixation that may empower vertebral augmentation and potentially avoid corpectomy in challenging fractures.

Procedure details This report provides step-by-step procedural details, rationale, and proposed indications for this procedure. The procedure is entirely percutaneous under fluoroscopic guidance. Through transpedicular trocars the VBS are inserted, balloon-expanded and implanted in the VB. Over k-wire exchange the transpedicular screws are inserted inside the lumen of the stents and cement is injected through the screws to augment the stents and fuse the screws to the stents.

Applications This technique may find appropriate applications for the most severe osteoporotic fractures with large clefts, high-degree fragmentation and collapse, middle column and pedicular involvement, and in extensive neoplastic lytic lesions.

Conclusions Stent-Screw-Assisted Internal Fixation (SAIF) might represent a minimally invasive option to obtain VB reconstruction and restoration of axial load capability in severe osteoporotic and neoplastic fractures, potentially obviating the need for more invasive surgical interventions in situations that would pose significant challenges to standard vertebroplasty or balloon kyphoplasty.

  • stent
  • neoplasm
  • metastatic
  • spine
  • technique
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Footnotes

  • Contributors All authors contributed to the presented work by substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work and drafting the work or revising it critically for important intellectual content and final approval of the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Ethics Committee of Canton Ticino.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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