Indication:
Painful compression fracture
Painful lytic mets/myeloma
Painful hemangioma
Contraindications:
Infection
Coagulopathy
Neurological compromise
Sevre vertebra plana
Posterior fracture
Acute trauma
Preparation:
Antibiotic cover?
Anaesthesia:
GA
Sedation and LA
Procedure:
Fluoroscopic guidance
Bone biopsy set, 11/13 guage
Bone cement with radio-opaque material (?antibiotic added to cement)
1-3 cc syringes 2-3 per vertebra
Not more than 3 vertebrae in the same setting
Lateral or prone (lateral preferred)
Target the pedicles - upper outer aspect, keep checking in AP and lateral views
Needle tip at anterior third of the vertebral body
While pushing the cement, look for cement leak outside the vertebra
While removing the needle, there should not be any back flow of the cement
Complications:
Cement leakage 27%, but further intervention in 1%
Paraplegia less than 5%
Results:
Relief of pain 58-97%
Regain lost mobility 75-93%
Patient satisfaction 100%
References:
