Injection of the cement
This phase of the procedure is controlled under strict lateral fluoroscopy. The injection of acrylic glue 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 . Six to seven minutes after mixing, the methyl methacrylate begins to harden. During this hardening time, the methyl methacrylate becomes hot (+/- 90 °C). 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 - 4 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 glue provides good pain relief. Illustration is provided in the cement injection movie cases.
Figure 7m. Injection of the cement.
Figure 7n. Injection of the cement under fluoroscopy .
Figure 7o. CT control.