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Imaging Findings of Vertebral Augmentation with CT Correlation – Helpful Fluoroscopic Features for the Interventionalist 2014

Category Interventional Arya Bagherpour Thomas O'Neill, MD Jorge Aguila, MD Melhem Ghaleb, MD Luis Ramos, MD Nassim Akle, MD Purpose Vertebral augmentation is a technique that is performed under fluoroscopic guidance. A thorough understanding of the imaging findings of the cement filling patterns is of critical importance to minimize complication risk and to optimize treatment. The purpose of this study is to illustrate the fluoroscopic imaging findings of various patients after vertebral augmentation, utilizing CT as a correlate, and to demonstrate the various routes of cement filling and leakage in patients with both pathologic and traumatic vertebral fractures. Materials & Methods A retrospective review of patients who had undergone vertebral augmentation, utilizing high viscosity PMMA cement, with post-procedural CT examinations at our institution was performed. The authors performed a comparative analysis of post-procedural fluoroscopic and CT imaging features, to identify certain imaging patterns of cement filling. Results Fluoroscopic and CT imaging features of PMMA cement filling and leakage patterns in the patients reviewed include: cement filling through fracture planes, peripheral zone of cement interdigitation, basivertebral vein extension, transpedicular cement leakage through osteotomy, superior and inferior endplate leakage, leakage into neuroforaminal space through cortical defect, filling of the posterior third of the vertebral body without retropulsion, cement filling in vertebral body osteonecrosis, cement filling in osteoporotic patient versus normal bone density. Conclusion Characterization of the cement filling patterns on post-procedure CT and intra-procedural fluoroscopy will aid the interventionalist performing vertebral augmentation to successfully identify routes of cement filling and identify potential procedural complications. References Nieuwenhuijse MJ, Van Erkel AR, Dijkstra PD. Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors. Spine J. 2011 Sep;11(9):839-48. Lin EP, Ekholm S, Hiwatashi A, Westesson PL. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol. 2004 Feb;25(2):175-80. Peh WC, Gelbart MS, Gilula LA, Peck DD. Percutaneous vertebroplasty: treatment of painful vertebral compression fractures with intraosseous vacuum phenomena. AJR Am J Roentgenol. 2003 May;180(5):1411-7.