J Korean Neurosurg Soc.  2012 Feb;51(2):120-123. 10.3340/jkns.2012.51.2.120.

Preliminary Report of Three-Dimensional Reconstructive Intraoperative C-Arm in Percutaneous Vertebroplasty

• Shin JH
• Jeong JH

• KMID: 1441424
• DOI: http://doi.org/10.3340/jkns.2012.51.2.120

Abstract

OBJECTIVE
Percutaneous vertebroplasty (PVP) is usually carried out under three-dimensional (2D) fluoroscopic guidance. However, operative complications or bone cement distribution might be difficult to assess on the basis of only 2D radiographic projection images. We evaluated the feasibility of performing an intraoperative and postoperative examination in patients undergoing PVP by using three-dimensional (3D) reconstructive C-arm.
METHODS
Standard PVP procedures were performed on 14 consecutive patients by using a Siremobil Iso-C3D and a multidetector computed tomography machine. Post-processing of acquired volumetric datasets included multiplanar reconstruction (MPR) and surface shaded display (SSD). We analyzed intraoperative and immediate postoperative evaluation of the needle trajectory and bone cement distribution.
RESULTS
The male : female ratio was 2 : 12; mean age of patients, 70 (range, 77-54) years; and mean T score, -3.4. The mean operation time was 52.14 min, but the time required to perform and post-process the rotational acquisitions was 7.76 min. The detection of bone cement distribution and leakage after PVP by using MPR and SSD was possible in all patients. However, detection of the safe trajectory for needle insertion was not possible.
CONCLUSION
3D rotational image acquisition can enable intra- or post-procedural assessment of vertebroplasty procedures for the detection of bone cement distribution and leakage. However, it is difficult to assess the safe trajectory for needle insertion.

Keyword

Vertebroplasty; Intraoperative 3D imaging; Complication; Feasibility

MeSH Terms

Female
Humans
Male
Multidetector Computed Tomography
Needles
Silver Sulfadiazine
Vertebroplasty
Silver Sulfadiazine

Figure

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  Fig. 1 A 54-year-old female with traumatic compression fracture at L1; we conducted unipedicular L1 vertebroplasty; reconstructed intraoperative conventional and rotational acquisition multiplanar reconstruction image.

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  Fig. 2 Photography shows preoperative (A) and intraoperative axial image. Intraoperative image (B) shows severe needle artifact.

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