British Journal of Radiology (2003) 76, 69-75
© 2003 British Institute of Radiology
doi: 10.1259/bjr/10254271
Percutaneous vertebroplasty: indications, contraindications, and technique
W C G Peh, FRCPE, FRCPG, FRCR
1 and
L A Gilula, MD, FACR
2
1 Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 and2 Mallinckrodt Institute of Radiology, Washington University Medical Centre, St Louis, MO, USA
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Figure 1. Pre-vertebroplasty axial CT scan shows extensive osteolytic involvement of the L3 vertebral body in a 56-year-old woman with carcinoma of the breast. There is destruction of the left pedicle. The patient eventually underwent surgical stabilization.
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Figure 2. Pre-vertebroplasty CT scan reformatted in the mid-sagittal plane shows mixed osteolytic-sclerotic involvement of L1 vertebral body in a 65-year-old man with carcinoma of the colon. There is destruction of the posterior vertebral cortex. Vertebroplasty was successfully performed.
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Figure 3. Sagittal short tau inversion recovery (STIR) MR image shows mild wedge compression of L1 vertebral body. The affected vertebra is hyperintense, in keeping with an acute or subacute injury. There is no significant retropulsion into the spinal canal.
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Figure 4. 11 G disposable bone biopsy needle used for percutaneous vertebroplasty. The stylet has a bevelled tip.
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Figure 5. C-arm in a horizontal position to check the lateral projection of the needle tip within the vertebral body. The vertebroplasty needle is held by sponge forceps (in the foreground) to lessen the radiation hazard to the radiologist's hand.
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Figure 6. Series of radiographs in a 69-year-old woman with metastatic deposits in L4 vertebra due to carcinoma of the breast. (a) Lateral radiograph shows mixed lytic-sclerotic involvement of a mildly compressed L4 vertebral body. (b) Slightly oblique prone radiograph shows the shaft of the needle maintaining a "target" or "bulls-eye" appearance within the left pedicle. (c) Lateral radiograph shows the needle tip in the anterior one third of the vertebral body. (d) PA prone radiograph shows the needle tip close to the midline. (e) PA prone radiograph shows polymethylmethacrylate (PMM) within the vertebral body. There is slight leakage of PMM adjacent to the left L3/4 disc annulus. (f) Lateral radiograph shows PMM opacification of most of the vertebral body.
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Figure 7. Lateral radiograph shows a 14 G quick core biopsy needle being placed coaxially through the outer 11 G vertebroplasty needle. This 79-year-old woman presented with painful compression fracture of L1 vertebral body and had a past history of carcinoma of the cervix. Vertebroplasty was subsequently performed.
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Figure 8. Photograph shows intraosseous venography performed via injection of non-ionic contrast agent through the connecting tube into the vertebroplasty needle placed within the vertebral body.
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Figure 9. Posteroanterior prone radiograph shows intraosseous venography performed through the vertebroplasty needle placed through the right pedicle. Opacification of the paravertebral veins is seen. The left half of the same vertebral body is filled by previous polymethylmethacrylate injection through the contralateral pedicle.
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Figure 10. (a) Lateral and (b) posteroanterior radiographs show even and near-complete polymethylmethacrylate (PMM) filling of a severely compressed T12 vertebral body in a 72-year-old woman with osteoporosis. (c) Post-vertebroplasty axial CT scan confirms near-complete PMM vertebral body filling. There is slight leakage of PMM into the anterior epidural space and paravertebral soft tissues.
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Figure 11. Posteroanterior prone radiograph shows bilateral pedicular punctures in a 67-year-old man with L3 osteoporotic compression fracture. The left needle had been removed following polymethylmethacrylate injection into the left half of the vertebral body.
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Figure 12. Lateral radiograph shows polymethylmethacrylate (PMM) leakage into the T6/7 disc of a 76-year-old woman with T6 osteoporotic compression fracture. The patient did not suffer any ill-effect from the intradiscal PMM placement.
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Copyright © 2003 by the British Institute of Radiology.
