Article Figures & Data
Figures
- Fig 1.
84-year-old man with osteoporosis and compression fractures at T12 and L1.
A, Sagittal T1-weighted MR image shows a severe T12 compression fracture with minor posterior wall displacement and an inferior endplate fracture at L1 with bone marrow edema.
B, Lateral fluoroscopic view of the T12 vertebral body confirms severe loss of vertebral height and documents a superior endplate fracture (arrowhead).
C, Lateral fluoroscopic view of T12 after placement of an 11-gauge needle by means of a right transpedicular approach. Because of the pedicle angulation and the superior endplate fracture, a suboptimal posterior needle tip position had to be accepted. The cement distributed within the vertebral body both anteriorly and posteriorly and crossed the superior endplate fracture plane to reach the disk space.
- Fig 2.
76-year-old woman with osteoporosis and multiple compression fractures.
A, Two-dimensional CT reconstruction in the sagittal plane shows L2 and L3 compression fractures, as well as a previously treated L5 fracture. Note the inferior and superior endplate fractures at L3.
B, Lateral fluoroscopic view of L3 after PV. Note the extension of the cement into both the inferior and superior endplate fracture lines. The L2 fracture was treated during the same session.
- Fig 3.
81-year-old man with T7 and T8 biopsy-proved metastases from unknown primary carcinoma.
A, Sagittal T1-weighted MR image shows a T7 metastatic lesion extending into the epidural space and into the T8 vertebral body through the T7–T8 disk space.
B, Lateral fluoroscopic view after T8 PV. The cement injected at T8 followed the extension pathway of the lesion and reached the inferior aspect of T7 via the T7–T8 disk space.
C, Anteroposterior fluoroscopic view shows that the cement distributed only along the inferior aspect of T7. To complete the treatment, a second needle was placed in the T7 vertebral body by means of a right transpedicular approach. Since both pedicles were involved by the metastatic process and not identifiable fluoroscopically, the medial wall of the pedicles located above and below were used as osseous landmarks (“virtual pedicle” technique).
- Fig 4.
63-year-old woman with osteoporosis and a compression fracture at L3 associated with a superior endplate Schmorl’s node.
A, Fluoroscopic view shows the 11-gauge needle that was placed by means of a right transpedicular approach. The presence of the Schmorl’s node precluded a median position of the needle tip. During PMMA injection, a leak (arrow) in the perivertebral venous system was immediately observed. The injection was resumed after a 20-second delay and completed uneventfully.
B, Fluoroscopic view shows a second needle that was placed by means of a left transpedicular approach. Again, note a small leak (arrow) in the perivertebral venous system. The Schmorl’s node is outlined by the cement deposition.
