Vertebroplasty in patients with severe vertebral compression fractures: a technical report

Abstract

Vertebroplasty is a procedure in which polymethlymethacrylate (PMMA) is injected into a vertebral body compression fracture. It has been suggested that fractues greater than 65% to 70% of the original vertebral body height are too compressed to be treated successfully with this procedure. We describe six patients with severe compression fractures that were successfully treated with vertebroplasty in which the trocar was inserted in the far lateral aspect of the vertebral body, because of the typical morphology of severe compression fractures.

fig 1.

Case 4. A, Anteroposterior radiograph of the T8 vertebral body. B, Lateral radiograph of the same vertebral body shows a severe compression fracture. C, Sagittal T2-weighted MR image of the T8 vertebral body again shows a severe compression fracture. This mid-sagittal image shows the most severe portion of the compression fracture at the center of the vertebral body. D, Sagittal T2-weighted MR image of the T8 vertebral body shows relative preservation of vertebral body height far laterally. E, Anteroposterior radiograph shows the 13-gauge trocar in the vertebral body via a parapedicular approach. Note the far lateral approach in the area of the vertebral body with relative preservation of bone marrow. F, Lateral radiograph shows placement of a 13-gauge bone trocar into the vertebral body. G, Anteroposterior radiograph after vertebroplasty with PMMA in the far lateral aspect of the vertebral body bone marrow. The typical bow-tie appearance of vertebral bodies with severe compression fractures is shown. H, Lateral radiograph after vertebroplasty with PMMA filling the residual vertebral body bone marrow.

fig 2.

Case 5 A, Anteroposterior radiograph of the T12 vertebral body. B, Lateral radiograph of the same vertebral body shows a severe compression fracture. C, Sagittal T1-weighted MR image shows a severe compression deformity at the center of the vertebral body with some retropulsion of the posterior vertebral body. D, Sagittal T1-weighted MR image shows relative preservation of vertebral body bone marrow far laterally (arrows). E, Lateral radiograph shows placement of an 11-gauge trocar into the T12 vertebral body. F, Lateral radiograph of the T12 vertebral body after vertebroplasty. G, Anteroposterior radiograph after vertebroplasty with PMMA in the far lateral position, as well as a small amount of PMMA underneath the superior endplate fracture in the midline.