Relevance of Antecedent Venography in Percutaneous Vertebroplasty for the Treatment of Osteoporotic Compression Fractures
John R. Gaughen, Jra,
Mary E. Jensena,
Patricia A. Schweickerta,
Timothy J. Kaufmanna,
William F. Marxa and
David F. Kallmesa
a From the Department of Radiology, University of Virginia Health Services, Charlottesville
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FIG 1. Images in a 77-year-old woman with an L1 vertebral body fracture.
A, AP digital subtraction venogram shows the tip of an 11-gauge needle (straight white arrow) at the midline of the vertebral body. Multiple routes of contrast material egress are present, including routes through the superior endplate (curved black arrow) and bilateral paravertebral veins (straight black arrows).
B, AP plain radiograph obtained after vertebroplasty shows that the tip of the needle remains at the midline (white arrow). The needle position has not been altered because direct or rapid venous filling during venography was not observed. Cement fills most of the vertebral body, and it has also extravasated into the superior disk space (black arrow), in the exact same pattern as that predicted by using the venogram in A.
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FIG 2. Images in a 83-year-old woman with a T6 vertebral body fracture.
A, Lateral digital subtraction venogram shows the tip of the needle (straight white arrow) in the midportion of the vertebral body. Contrast material exits rapidly via a prevertebral vein (straight black arrow) and empties into the hemiazygos vein (curved black arrow). The rapid venous filling warranted an increase in the viscosity of the cement to minimize potential complications.
B, Lateral plain radiograph obtained after vertebroplasty shows that cement fills most of the vertebral body and that is has extravasated into both the superior and inferior endplates (arrows). No evidence for prevertebral cement extravasation is present.
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AJNR - American Journal of Neuroradiology