fluoroscopy guidance

Puncture under fluoroscopic guidance

• For fluoroscopic guidance, the patient is positioned prone.
• The appropriate radiographic profile for pedicular approach is a straight anteroposterior view, with 5° to 10° angulation.
• The pedicle is localized with fluoroscopy and appears oval in shape. The needle is advanced into the pedicle under fluoroscopic control. For an optimal approach, the entry point and its distance from the midline (spinous process) can be measured on the axial CT scan or MR film of the patient.
• The needle tip is positioned in the anterior part of the vertebral body. With this technique, the needle is placed in the ipsilateral half of the vertebra.
• With this technique, a bipediculate approach is often necessary for an optimal filling of the vertebral body.
• After injection of the cement in one side, placement of the needle in the opposite pedicle prolongs duration of the procedure and increase the risk of extravasation.

Figure 7g. Puncture under fluoroscopy control. Posterolateral, intercostal approach at an angle 35° from the patient´s sagittal plane.

Figure 7h-i. Diagram of anatomical relations in 35° oblique procubitus position. 1 Transverse process. 2 Costovertebral joint. 3 Disk. 4 Controlateral lamina. 5 Vertebral body. 6 External edge of the articular process. 7 Line of pleural reflection. 8 Rib head. Puncture showed in red represents the cementoplasty needle under fluoroscopy control. Posterolateral, intercostal approach at an angle 35° from the patient´s sagittal plane