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. 2022 Apr;40(4):419-429.
doi: 10.1007/s11604-021-01216-3. Epub 2021 Nov 5.

Accuracy of vertebral puncture in percutaneous vertebroplasty

Tomoyuki Noguchi  1   2   3   4 , Koji Yamashita  5 , Yoshitaka Shida  6 , Takashi Okafuji  6 , Ryotaro Kamei  5 , Junki Maehara  5 , Tsuyoshi Tajima  6
Affiliations

Accuracy of vertebral puncture in percutaneous vertebroplasty

Tomoyuki Noguchi et al. Jpn J Radiol. 2022 Apr.

Abstract

Purpose: To clarify the accuracy of vertebral puncture of the vertebral tertile area needling (VETERAN) method puncturing the pedicle superimposed on one-third of the width between the lateral vertebral line to the contralateral medial lamina line compared with Cathelin-needle-assisted puncture (CAP) method puncturing using the Cathelin needle as a guide in percutaneous vertebroplasty.

Materials and methods: 449 punctures by CAP method and 125 punctures by VETERAN method were enrolled. We compared the puncture accuracy of both methods. We estimated a vertebral estimated tilting ratio (VET-ratio) defined as ratio of the distance between the lateral vertebral line and the contralateral medial laminal line to the distance between the vertebral lateral line and the puncture point measured by computed tomography. We also estimated the procedural items and clinical outcomes.

Results: VETERAN method with 100% of punctures within safe zone (cortical breaches within 2 mm) had significantly higher accuracy than CAP method with 97.8% (p < 0.01) for the 2 mm incremental evaluation. No cases with a VET-ratio of 36% or less had cortical breaches. VETERAN method had shorter operative time per puncture (p < 0.01) and exposure time per puncture (p < 0.05).

Conclusion: VETERAN method reduced the occurrence of the inaccurate puncture, operative times, and exposure times. A VET-ratio with 36% or less is associated with a safe puncture using VETERAN method.

Keywords: Back pain; Needles; Punctures; Spine; Vertebroplasty.

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Conflict of interest statement

The authors wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Figures

Fig. 1
Fig. 1
An IVR-CT image (a) and Cone-beam CT images (b and c) of the vertebral body after the bone biopsy needle insertion. Cases a, b, and c are Grade A (no cortical breach) in medial breaches, Grade B (the cortical breach with 2 mm or less) in medial breaches, and Grade C (the cortical breach with 4 mm or less) in lateral breaches, respectively, according to Gertzbein and Robbins classification scores based on CT commonly used to assess the pedicle screw placement in spinal surgery
Fig. 2
Fig. 2
A left anterior oblique fluoroscopic view of the lumbar vertebral body before puncturing (a) and an IVR-CT image of the lumbar vertebral body after the insertion of the bone biopsy needle (b). The right, center, and left vertical arrows in (a) and (b) indicate the lateral medial lamina line, the puncture point, and the contralateral vertebral line, respectively. Vertebral estimated tilting ratio (VET-ratio) is equal to y/x (%), where ‘x’ represents the distance between the lateral vertebral line and the contralateral medial lamina line and ‘y’ represents the distance between the vertebral lateral line and the puncture point shown in (a) and (b). VET-ratio should be 33% in VETERAN method
See this image and copyright information in PMC

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