[Pathology and Acute Phase Treatment of Osteoporotic Vertebral Fractures:Indications and Techniques for Vertebroplasty].

Abstract

Vertebroplasty has shown excellent analgesic effects in patients with osteoporotic vertebral fractures. In Japan, percutaneous vertebroplasty, balloon kyphoplasty, and vertebral body stenting are commonly performed. All of these techniques require precise transpedicular vertebral puncture and complete cement filling without leakage. Puncture should only be performed after accurately identifying the upper and lower end plates of the vertebral body, lateral borders, and pedicles using combined frontal and lateral fluoroscopic images. In the frontal view, the puncture was made from the lateral cranial side of the pedicle toward the center of the vertebral body. In the lateral view, before passing through the medial wall, the tip had entered the vertebral body and advanced to the anterior quarter. Bone cement within the vertebral body can permeate the trabecular spaces or accumulate as a single mass. To prevent leakage, the movement of the injecting finger should be aligned precisely with the fluoroscopic images. Awareness of the three leakage patterns and basivertebral, segmental, and cortical veins, is crucial. Potential lateral leakage outside the vertebral body must be focused. The injection was terminated as the cement reached the posterior quarter.