Biopsy & phlebogram

• Vertebral body biopsy (if necessary) can be performed using the coaxial technique before cement injection. A 14-gauge bone biopsy needle (Ostycut®) is used coaxially (Fig.1, 2).

Fig. 1:  Coaxial vertebral biopsy before cement injection.

Fig. 2: Vertebral body biopsy under lateral fluoroscopy control.

• Vertebral venography is only performed in hypervascularized lesions and /or in case of blood backflow after the removal of the vertebroplasty needle stylet. If the needle tip is inside a vertebral vein, the position should be modified. 

Play movie of the case (avi 720*576 hi res divx-mepg4 movie)

 Fig. 3: Blood overflow through the cannula.

Fig. 4:  Vertebral venography. Needle inside venous structure requiring modification of needle position

Fig. 5: Vertebral venography. Vertebral central main vein (hollow arrow I). Epidural veins (arrow I). Anterior spinal veins (arrow II). Vertebroplasty previous levels (arrow III). The needle position was modified.