• - Persistent pain due to
  • . a vertebral compression fracture (posttraumatic, neoplastic or osteoporotic)
  • . a lytic metastasis
  • . an aggressive angioma

Target: Anterior third of the vertebral body

Procedure:

• - Patient in prone position with i.v. drip
• - Axial scan to determine angle of approch and target slice
• - Routes for vertebral puncture:
  • . transpedicular (mostly used route)
  • . intercostovertebral (thoracic spine)
  • . posterolateral (lumbar spine)
  • . anterolateral (cervical spine)
• - Local anesthesia from facet joint to skin
• - CT fluoroscopic guidance for a one-sided vertebral puncture with a dedicated 13 or 11 gauge needle (sometimes, use of a mallet is necessary)
• - Cement preparation
• - Cement injection with continuous triple slice CT fluoroscopy to evaluate diffusion
• - Stop procedure if cement leak
• - Bedrest for 4 hours

Danger:

• -Avoid nerve root if posterolateral approach
• -Cement leakage in epidural space (if posterior wall is damaged), in veins (may cause pulmonary embolism)