Value of the vertebrogram in predicting cement filling patterns with unipedicular percutaneous vertebroplasty.
BACKGROUND
Unipedicular vertebroplasty can be successful in selected patients to decrease procedure time, sedation amounts, and cost.


OBJECTIVE
To evaluate the value of the antecedent unipedicular vertebrogram in predicting patterns of cement deposition to decide whether unipedicular vertebroplasty will be successful, or if a bipedicular vertebroplasty is needed.


METHODS
75 fractured vertebral levels were injected by a unipedicle approach with iodinated contrast material (vertebrogram). This filling pattern was then compared to the cement deposition pattern, via the same pedicle, of the percutaneous vertebroplasty.


RESULTS
35 levels showed excellent cross-filling and matched pattern by vertebrogram and cement deposition (47%). Twelve levels (16%) showed cross-filling by both techniques, with less than 100% matched pattern, but cement deposition was considered adequate for fracture treatment. Four levels (5%) showed predominantly matched central filling, considered adequate for fracture treatment. Twenty-one levels (28%) showed only matched filling of half of the vertebral body with both techniques, necessitating a bipedicle approach for treatment with cement. The remaining three levels (4%) demonstrated mismatched patterns between the vertebrogram and the cement deposition, necessitating a bipedicular approach.


CONCLUSIONS
The unipedicular vertebrogram was helpful in predicting adequate cement deposition, using a single pedicle, in 51 of 75 cases (68%). The vertebrogram was also accurate in predicting the need for a double-pedicle technique in an additional 21 cases (28%). Therefore, the vertebrogram was very helpful in predicting the route of cement deposition in 72 of 75 (96%) cases, and should be considered as an adjunct to percutaneous vertebroplasty.
Ormsby
E L
EL
Section of Neuroradiology, Department of Diagnostic Radiology, University of California, Davis, School of Medicine, Sacramento, California, USA.
Dublin
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AB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D013131:Spine / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*
D001843:Bone Cements; D003287:Contrast Media