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Needle Manipulation Techniques

Use of the needle bevel to control the direction of the needle:


  • At the entry point, with a stiff needle, the direction can still be corrected only by changing directly the angulation (see Fig. 1). However, after deep penetration in bone, the needle angulation is difficult to modify. Therefore the needle direction should be adjusted by this method before deep bone penetration.
  • After cortical perforatio. Once deep  inside bone it is usually not anymore possible to change the direction of the needle directly. We prefer the beveled vertebroplasty needles for this reason. A notch exists on one side of the hub that corresponds to the side of the bevel face (Fig.2). Once in bone, the needle bevel can be used to adjust slightly the direction of the needle Even, cement distribution can be adapted in the vertebral body by modifying the bevel direction during injection. Because the beveled needle tip is wedge shaped, this facilitates directional needle placement. It works even when the needle is deep inside the vertebral body. According to the bevel face direction (right, left, up or down) the course of the needle is modified. The needle is forced in a direction opposite to the bevel face. For example, when the bevel face and the notch are cephalad then the bevel face is pointed cephalad and the needle will be directed caudad.  This technique allows an optimal placement of the vertebroplasty needle (see Fig.3 to 7).The stylet should always remain within the cannula during needle placement.



Fig. 1: Needle positioning before penetration of the coratical bone. Once the sharp tip of the needle is inserted in the periosteum, the needle direction can be modified by changing the angulation at the entry point.

 

Fig. 2: Percutaneous Cementoplasty Cemento┬« set (Optimed/Germany), 10-gauge needle, handy metal wings for an easy insertion / removal and easy rotation of the needle, special beveled edge (arrow 2). Notch indicating the bevel face (arrow 6 &7)   Metal protrusion to fix the stylet (arrow 4) on the hub (arrow 5). The outer cannula (arrow 1). The bevel face (arrow 8).

 

 

The principle of the vertebroplasty needle bevel:

Fig. 3: The hub notch in medial position, bevel tip in medial position leading the course of the needle to the side (blue arrow).

Fig. 4: The hub notch in side position, bevel tip in lateral position leading the course of the needle medially (blue arrow).

Fig. 5: The hub notch in side position, bevel face in lateral position leading the course of the needle medially (blue arrow). The needle is in contact with the spinal canal, it should be corrected.

Fig. 6: Changing the bevel face direction by turning the connector 180┬░.  The hub notch in medial position, bevel face in medial position leading the course of the needle to the side (blue arrow).

Fig. 7: Hammering, needle course correction.