PT  - JOURNAL ARTICLE
AU  - Alessandro Cianfoni
AU  - Daniela Distefano
AU  - Maurizio Isalberti
AU  - Michael Reinert
AU  - Pietro Scarone
AU  - Dominique Kuhlen
AU  - Joshua A Hirsch
AU  - Giuseppe Bonaldi
TI  - Stent-screw-assisted internal fixation: the SAIF technique to augment severe osteoporotic and neoplastic vertebral body fractures
AID  - 10.1136/neurintsurg-2018-014481
DP  - 2019 Jun 01
TA  - Journal of NeuroInterventional Surgery
PG  - 603--609
VI  - 11
IP  - 6
4099  - http://jnis.bmj.com/content/11/6/603.short
4100  - http://jnis.bmj.com/content/11/6/603.full
SO  - J NeuroIntervent Surg2019 Jun 01; 11
AB  - 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.