Devoted to diagnostic and interventional spine imaging and therapeutics



Interventional Spine

Luigi, Manfre, MD



The posterior arch and the spinous processes/laminae complex can be involved in several disease. In case of severe arthrosic and/or osteoporosys contact of spinous processes related to disc degeneration can generate local chronic pain, resistant to chemical (steroid infiltration) or physical (radioablation) therapy. Moreover, osteoporosys can be responsible for laminae remodeling in patients treated with interspinous devices (ISD) because of symptomatic spinal canal stenosis. We evaluate the possibility to perform cementoplasty of the spinous proceses (spinoplasty - SP) in patients affected by posterior arch painful edema and in patients affected by severe osteoporosys candidate to ISD.

Methods & Materials

Among 1244 patients undergone Vertebroplasty procedures, 3 cases were affected by focal lumbar pain related to spinous processes edema demonstrated on MRI. Among 154 patients affected by painful lumbar spinal canal stenosis, 12 were affected by severe osteoporosis. In all the patients with painful spinous process edema, MRI revealed abnormal signal intensity inside the posterior arch of L3, L4 and L5 vertebra. In patients candicated to ISD treatment, severe spinal canal stenosis with normal appearance of the posterior arch were appreciated. SP was performed using a CTguided technique, 13G needles and 1 to 3cc of PMMA per level.


Patients affected by painful spinous processes edema became painless in 24 hours after SP and no complication was detected at 1week-3months follow-up controls. Patients undergone prophylactic SP before ISD implant had no recurrence of pre-op symptoms nor laminae remodeling at 3, 6 and 12 months control.


Vertebroplasty of the posterior arch using CT-guided PMMA injection seems to be a powerful technique in those patients who need posterior arch augmentation.

References/Financial Disclosures

David H. Kim and Todd J. Albert Interspinous Process Spacers J. Am. Acad. Orthop. Surg., April 2007; 15: 200 - 207 Ryan D. Murtagh, Robert M. Quencer, Antonio E. Castellvi, and James J. Yue New Techniques in Lumbar Spinal Instrumentation: What the Radiologist Needs to Know Radiology, August 2011; 260: 317 - 330.