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Intravertebral Clefts Opacified during Vertebroplasty: Pathogenesis, Technical Implications, and Prognostic Significance

John I. Lanea, Timothy P. Mausa, John T. Walda, Kent R. Thielena, Shalabh Bobraa and Patrick H. Luetmera

a From the Mayo Clinic, Department of Radiology, Section of Neuroradiology, Rochester, MN



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  		FIG 1. Lateral radiographs show two patterns of opacification after polymethylmethacrylate cement injection. Corresponding MR image is shown.

A, Trabecular pattern of opacification represents opaque cement interspersed throughout the trabecular space (arrow).

B, Cleft pattern of opacification represents opaque cement filling a large sub-end plate cavity (arrow).



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  		FIG 2. Fluid-filled sub-end plate cleft.

A, Sagittal T2-weighted MR image shows cleft in association with a vertebral compression fracture (arrow).

B, Lateral radiograph shows opacification of cleft after cement injection (arrow). Note small amount of prevertebral extravasation of cement.



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  		FIG 3. Air-filled sub-end plate cleft.

A, Lateral radiograph obtained before vertebroplasty shows cleft associated with compression fracture (white arrows).

B, Lateral radiograph shows opacification of this cleft after polymethylmethacrylate injection (black arrows).



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  		FIG 4. Graph shows mean numerical pain scores (NPS) recorded in intravertebral cleft versus non-cleft groups at preprocedural baseline, 1 week, 6 months, and 12 months after vertebroplasty. Black bars, cleft group; gray bars, non-cleft group.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X