BackTable / MSK / Podcast / Episode #24
Unipedicular vs. Bipedicular Approach for Kyphoplasty
with Dr. Thomas Andreshak
Interventional radiologist Michael Barraza talks with orthopedic spine surgeon Thomas Andreshak about his approach to vertebral augmentation for compression fractures, including unipedicular vs. bipedicular approach, technique pearls, and post-procedure care.
BackTable, LLC (Producer). (2023, July 26). Ep. 24 – Unipedicular vs. Bipedicular Approach for Kyphoplasty [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Thomas Andreshak
Dr. Thomas Andreshak is an orthopaedic spine surgeon at Consulting Orthopaedic Associates, Inc. in Toledo, Ohio.
Dr. Michael Barraza
Dr. Michael Barraza is a practicing interventional radiologist (and all around great guy) with Radiology Associates in Baton Rouge, LA.
In this episode, orthopedic surgeon Dr.Thomas Andreshak and our host Dr. Michael Barraza discuss kyphoplasty technique, including different methods of imaging, approaches, sedation, and follow-up.
Dr. Andreshak starts with obtaining a standing X-ray because it allows him to better observe cases of spondylolisthesis. He describes both unipedicular and bipedicular approaches, noting that the unipedicular approach can allow for greater cost savings, less cement used, and lower radiation exposure.
The doctors also review the stages of bone healing: hematoma formation, fibrocartilage formation, bony callus formation, and bone remodeling. Dr. Andreshak warns against overfilling the vertebra, which creates stiffness and puts stress on the adjacent endplate. Finally, they discuss follow-up and considerations for future treatment if pain persists.
Consulting Orthopedic Associates:
[Dr. Michael Barraza]:
You're doing them then, what's your end point when you're treating these in terms of cement fill? Do you use a volume or do you use kind of imaging findings? That's something, I mean endpoint it's been a challenge for me since I started doing these. I will go to great lengths to not reflux cement. I'm so nervous about getting into the epidural space or something like that. And to this day I haven't done that, but you know, I see some people out there, you see cases shared on Twitter where people are really aggressive and you see these vertebral bodies that are entirely black. I haven't been able to pull the trigger on going to that length.
[Dr. Tom Andreshak]:
That has been the trend but I think it's falling away. In the beginning, the fill was important. We used to fill 3 cc balloon, we only filled 3 cc’s. Early studies in the early 2000s showed that if we don't get the bone interdigitating between the compacted bone, you lose your end plate.
So you collapse a little bit, lose your reduction or your height. The trend then was to go to a fuller fill, bigger balloons, and maximize the fill. In terms of orthopedics, we always say it's about the reduction. So force equals pressure times area. The more force with the balloon, including the second generation balloons, over a larger surface area with more force got your reduction. But that also compacted the bone so much that we ended up having a very stiff vertebragrams, I call it, where yes, it's this big black cement filled vertebrae. And we know that that puts some stress on the adjacent end plates. So I was always feeling a little bit more trying to make sure I filled the clefts and the crevices without overfilling, but it's tough to do because it's all patient variables. So I've actually gone to little bit less trying to get not as expanded balloon, get my reduction, but don't overfill.
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