Cement Injection

• This phase of the procedure is controlled under strict lateral fluoroscopy. The injection of acrylic cement is stopped immediately whenever an epidural or paravertebral opacification is observed in order to prevent spinal cord compression. When vertebral filling is insufficient, a contra-lateral injection is suggested in order to complete the filling. After the vertebral filling, the mandrin of the needle is replaced again under fluoroscopic control before the cement begins to set (because the needle itself contains about 1 ml glue). Then the needle is removed carefully .
• PMMAs have a long setting time (8 minutes, depending on the ambient temperature) and during that time, the cement keeps almost the same viscosity. Those two conditions allow a safe injection in the bone with an appropriate injection set. The patient should be under neureuleptanalgesia to control pain. Monitoring of the arterial pressure is necessary during the procedure because methyl methacrylate injections can induce transient hypotension. Total procedure time ranges from 20 to 50 minutes.
• In patients with osteoporosis and symptomatic hemangioma, an optimal filling (2.5 - 8 ml) of the vertebral body is required to obtain both effects of percutaneous vertebroplasty : consolidation and pain relief. In patients with tumoral pathologies, percutaneous cementoplasty is usually performed for excruciating pain. In these cases, a low volume (1.5 - 2.5 ml) of acrylic cement provides good pain relief.

Fig. 1: Injection of the cement.

Fig. 2: Injection of the cement under lateral fluoroscopy control.