overview

Technique overview

The procedure is performed under local anesthesia usually combined with neuroleptanalgesia. The patient is placed in the prone position for lumbar and thoracic level and in the supine position for cervical level. A 15-gauge needle is used for cervical vertebral bodies, a 10-gauge needle for thoracic and lumbar vertebrae. We use dual guidance : CT and C-arm fluoroscopy or biplane fluoroscopy. The entry point and the pathway are determined by CT, avoiding the nerve root and visceral structures. The needle is safely guided under CT or biplane fluoroscopy. Once the needle is in the optimal position, the imaging mode is switched to fluoroscopy. The acrylic cement mixed with tantalum (to increase radio-opacity) has to be injected during its pasty polymerization phase to prevent distal venous migration. The injection of glue is carefully controlled under strict lateral fluoroscopy. The injection of glue is stopped
whenever an epidural or paravertebral opacification is observed or when the glue reaches the posterior quarter of the vertebral body.

Figure 3. Percutaneous Cementoplasty: sagittal plane, vertebral filling.