Yonsei Med J.  2005 Oct;46(5):635-642. 10.3349/ymj.2005.46.5.635.

Real-time CT Fluoroscopy (CTF) -Guided Vertebroplasty in Osteoporotic Spine Fractures

• Kim JH
• Park KS
• Yi S
• Shin HC
• Yoon DH
• Kim KN

• KMID: 2158142
• DOI: http://doi.org/10.3349/ymj.2005.46.5.635

Abstract

The purpose of this study was to evaluate the clinical feasibility, benefits, and limitations of CT fluoroscopy (CTF) -guided percutaneous vertebroplasty (PVP). PVP under the guidance of CTF without additional guidance by conventional C-arm fluoroscopy was performed in a total of 29 vertebral bodies in 21 patients with vertebral compression fractures. While monitoring sectional CTF images, the needle was advanced from the skin to the target vertebra. Contrast media and polymethylmethacrylate (PMMA) were injected into the target vertebra with careful monitoring of their distribution. After the procedure, an evaluation was conducted to determine whether extraosseous leakage of PMMA occurred and whether sufficient filling of PMMA had been achieved. Needle placement into the target vertebra was easily achieved with both the transpedicular and posterolateral approaches. Injection of PMMA and venous leakage of contrast media were carefully monitored in all patients, and early detection of PMMA leaking was achieved in 5 patients. Extraosseous leakage that had not been detected during the procedure was not found upon postoperative evaluation. Pain scales were significantly decreased after the procedure, and no obvious complications occurred following the procedure CTF-guided PVP without the combined use of C- arm fluoroscopy was feasible and showed definite benefits. We believe that, in spite of some limitations, CTF-guided PVP provides an alternative technique appropriate in certain situations.

Keyword

Compression fracture; osteoporosis; vertebroplasty; CT fluoroscopy

MeSH Terms

Tomography, X-Ray Computed
Spine/radiography/*surgery
Spinal Fractures/*surgery
Radiation Dosage
Polymethyl Methacrylate
Osteoporosis/*complications
Orthopedic Procedures/*methods
Middle Aged
Male
Humans
Fluoroscopy
Female
Aged, 80 and over
Aged

Figure

• 

  Fig. 1 Fifty-seven year-old female patient who complained of back pain that was unrelieved with medication. A. Thoracolumbar lateral radiograph shows a compression fracture of the T12 vertebra. C-D. Transpedicular needle placement was performed through the right pedicle. The needle tip was placed at the anterior one-third of the T12 vertebral body. E. CT venography shows contrast media leakage into the marrow space of the vertebral body and venous channel. F. PMMA was injected and mainly filled in the right portion of the vertebral body. G-H. Needle placement to the left portion of the vertebral body was subsequently performed through the left pedicle, and PMMA was injected.

• 

  Fig. 2 Sixty-eight year-old female patient with osteoporosis. A. MRI shows compressive contour changes and marrow edema of the T11 vertebral body. C-D. The transpedicular approach for PVP was performed under guidance of CTF. F. PMMA injection began, and gradual filling of PMMA in the vertebral body was subsequently monitored on CTF. G. After filling in the right and anterior portion of the vertebral body, initiation of epidural PMMA leaking was monitored on CTF. PMMA injection was ceased immediately.

• 

  Fig. 3 Change of VAS of pain at the pre-operative period, immediate post-operative period, discharge, and last follow-up period (12 weeks after procedure). VAS was decreased significantly after PVP. *p < 0.05 by paired t-test between pre-op (pre-operative state) and post-operative period, at discharge, and last follow-up period.

Reference

1. Cotten A, Boutry N, Cortet B, Assaker R, Demondion X, Leblond D, et al. Percutaneous vertebroplasty: state of the art. Radiographics. 1998. 18:311–320. discussion 320-323.

2. Mathis JM, Barr JD, Belkoff SM, Barr MS, Jensen ME, Deramond H. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. Am J Neuroradiol. 2001. 22:373–381.

3. Jarvik JG, Deyo RA. Cementing the evidence: time for a randomized trial of vertebroplasty. Am J Neuroradiol. 2000. 21:1373–1374.

4. Cyteval C, Sarrabere MP, Roux JO, Thomas E, Jorgensen C, Blotman F, et al. Acute osteoporotic vertebral collapse: open study on percutaneous injection of acrylic surgical cement in 20 patients. Am J Roentgenol. 1999. 173:1685–1690.

5. Barr JD, Barr MS, Lemley TJ, McCann RM. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine. 2000. 25:923–928.

6. Gangi A, Dietemann JL, Mortazavi R, Pfleger D, Kauff C, Roy C. CT-guided interventional procedures for pain management in the lumbosacral spine. Radiographics. 1998. 18:621–633.

7. Gangi A, Kastler BA, Dietemann JL. Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy. Am J Neuroradiol. 1994. 15:83–86.

8. Gangi A, Guth S, Imbert JP, Marin H, Dietemann JL. Percutaneous vertebroplasty: indications, technique, and results. Radiographics. 2003. 23:e10.

9. Katada K, Kato R, Anno H, Ogura Y, Koga S, Ida Y, et al. Guidance with real-time CT fluoroscopy: early clinical experience. Radiology. 1996. 200:851–856.

10. Meyer CA, White CS, Wu J, Futterer SF, Templeton PA. Real-time CT fluoroscopy: usefulness in thoracic drainage. Am J Roentgenol. 1998. 171:1097–1101.

11. Froelich JJ, Saar B, Hoppe M, Ishaque N, Walthers EM, Regn J, et al. Real-time CT-fluoroscopy for guidance of percutaneous drainage procedures. J Vasc Interv Radiol. 1998. 9:735–740.

12. Silverman SG, Tuncali K, Adams DF, Nawfel RD, Zou KH, Judy PE. CT fluoroscopy-guided abdominal interventions: techniques, results, and radiation exposure. Radiology. 1999. 212:673–681.

13. Paulson EK, Sheafor DH, Enterline DS, McAdams HP, Yoshizumi TT. CT fluoroscopy-guided interventional procedures: techniques and radiation dose to radiologists. Radiology. 2001. 220:161–167.

14. Carlson SK, Bender CE, Classic KL, Zink FE, Quam JP, Ward EM, et al. Benefits and safety of CT fluoroscopy in interventional radiologic procedures. Radiology. 2001. 219:515–520.

15. Lee BJ, Lee SR, Yoo TY. Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate: a case report. Spine. 2002. 27:E419–E422.

16. Gaughen JR Jr, Jensen ME, Schweickert PA, Kaufmann TJ, Marx WF, Kallmes DF. Relevance of antecedent venography in percutaneous vertebroplasty for the treatment of osteoporotic compression fractures. Am J Neuroradiol. 2002. 23:594–600.

17. Gailloud P, Beauchamp NJ, Martin JB, Murphy KJ. Percutaneous pediculoplasty: polymethylmethacrylate injection into lytic vertebral pedicle lesions. J Vasc Interv Radiol. 2002. 13:517–521.

18. Kirchner J, Kickuth R, Laufer U, Schilling EM, Adams S, Liermann D. CT fluoroscopy-assisted puncture of thoracic and abdominal masses: a randomized trial. Clin Radiol. 2002. 57:188–192.

19. Irie T, Kajitani M, Itai Y. CT fluoroscopy-guided intervention: marked reduction of scattered radiation dose to the physician's hand by use of a lead plate and an improved I-I device. J Vasc Interv Radiol. 2001. 12:1417–1421.