Case ReportA “rising” transpedicular access to anterior vertebral body: A case report

- A safe and secure surgical approach to anterior vertebral body from inferior pedicle through intervertebral disc.
- A surgical option when screws of a precedent stabilization are placed on the way.
- A new surgical access route in order to perform a “one-act” injection for a vertebroplasty or a biopsy on different structures.
- A new approach avoiding “noble” structures such as peritoneum, pleura and segmental artery.

IntroductionThe transpedicular access is a common and effective procedure used to reach anterior vertebral body without passing through critical structures. after a transpedicular instrumentation, it is difficult to reach the anterior vertebral body because screws are placed in the way. We assume that an innovative transdiscal route could be used in patients with previous instrumentation, in order to perform a vertebroplasty or biopsy.Presentation of caseWe report the case of a 65-years-old woman who came to our Department complaining low back pain. Neurological examination showed a stable L4 wedge fracture under a previous lumbar L3-L4 posterolateral fusion performed 2 years before.DiscussionIn order to perform a vertebroplasty and a biopsy of the collapsed L4 anterior vertebral body we had to deal with transpedicular screws, which prevent any standard transpedicular pproach.ConclusionIn order to reach the L4 collapsed body we used an ascending transpedicular approach. We performed a biopsy and a subsequent vertebroplasty. Two days after surgery the patient reported a complete pain remission and was allowed to walk.