Transpedicular vertebroplasty for the repair of osteoporotic vertebral compression fracture has become popular in recent years because that the procedure is minimally invasive, and rapid postoperavie pain relief is obtained. However, extrusion of the injected material beyond the confines of the vertebral body is not rare. Therefore transpedicular vertebroplasty for the treatment of osteoporotic vertebral collapse in which bone fragments protrude into the spinal canal is considered to be a contraindication because of the increased risk of leakage of the material into the epidural space and consequent narrowing of the spinal canal. For two such cases, we injected bioactive bone substitute, calcium phosphate cement (CPC), through a small hole made in the lateral wall of the vertebral body. There was no leakage of the material and pain relief was achieved immediately after the operation. Vertebral collapse was arrested during the follow-up. The procedure of new vertebroplasty is described in this paper. Under general anesthesia the patient is placed in a lateral position. The lateral wall of the collapsed vertebra is exposed through the extrapleural approach. If the spinal cord is compressed by the protruded bone fragments, decompression before vertebroplasty is an option. A small hole is made in the lateral cortical bone of the vertebral body. The cancelous bone is curettaged to make a cavity which is filled with the material. CPC is injected into the cavity through the hole. Patients are allowed to walk, or sit in a chair without wearing a girdle after at least 3 days bed rest. The advantages of this method are as follows. 1) It is possible to decompress the spinal cord and simultaneously perform the vertebroplasty. 2) The bone substitute is injected safely and securely without leakage. 3) As both spinal fixation and bone grafting are not necessary, postoperative care is easy without wearing a girdle. 4) Immediate pain relief is obtained postoperatively.
