Case

INTERCOSTOVETEBRAL ROUTE

Play movie of the case (avi 350*240 pix mepg4 movie)

• FLUOROSCOPIC GUIDANCE

Fig. 1: puncture under oblique fluoroscopy control. Oblique projection at 35° angle from the patient's sagittal plane. A 22-gauge spinal needle is advanced to the costovertebral joint under oblique fluoroscopic control.

Fig. 2: The vertebroplasty needle is positioned parallel to the spinal needle.

Fig. 3: The vertebroplasty needle is positioned between the head of the rib and the transverse process.  The tip of the needle is in contact with the vertebrae. The fluoroscopy view is switched to lateral projection.

Fig. 4:  Lateral fluoroscopy view. The needle direction can be easily modified at this step. The vertebroplasty needle is then advanced under lateral projection with the help of a surgical hummer. 

Fig. 5:  Lateral fluoroscopy view. The vertebroplasty needle is advanced under lateral fluoroscopic control. The needle tip is positioned in the anterior one third of the vertebral body.

• CT GUIDANCE

Fig. 6: 22-gauge spinal needle placement  under CT control.

Fig. 6:  Tandem technique. Insertion of vertebroplasty needle.

Fig. 7: The vertebroplasty needle approaches the midline.