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Percutaneous Vertebroplasty:Treatment of Painful Vertebral Compression Fractures with Intraosseous Vacuum Phenomena

Wilfred C. G. Peh1,2, Michael S. Gelbart2, Louis A. Gilula2 and Dallas D. Peck2,3

1 Department of Diagnostic Radiology, Singapore General Hospital, Outram Rd., Singapore 169608.
2 Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, MO 63110.
3 Present address: Gem State Radiology, 877 W. Main St., Ste. 603, Boise, ID 83702.



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  		Fig. 1A. —68-year-old woman with compression fracture of T8 vertebral body. Lateral radiograph shows horizontal vacuum cleft (arrows) in inferior aspect of T8 vertebral body. Note T10 compression fracture.

 


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  		Fig. 1B. —68-year-old woman with compression fracture of T8 vertebral body. Axial CT scan obtained through lower T8 vertebra confirms intraosseous vacuum phenomenon.

 


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  		Fig. 1C. —68-year-old woman with compression fracture of T8 vertebral body. Lateral radiograph obtained during vertebroplasty shows needle positioned posteriorly in T8 vertebral body.

 


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  		Fig. 1D. —68-year-old woman with compression fracture of T8 vertebral body. Lateral radiograph after polymethyl methacrylate injection shows filled cleft (arrowheads) and opacification of posterior two thirds of T8 vertebral body. Note increased height of vertebral body compared with A.

 


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  		Fig. 2A. —75-year-old man with fracture of L1 vertebral body. Lateral radiograph shows gas-filled fracture cleft in L1 vertebral body. Note intradiscal gas in T12-L1 disk.

 


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  		Fig. 2B. —75-year-old man with fracture of L1 vertebral body. Sagittal T1-weighted spin-echo MR image shows low-signal cleft in L1 vertebral body located anteriorly near superior endplate, with low-signal fluid at posterior aspect of cleft (arrowheads).

 


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  		Fig. 2C. —75-year-old man with fracture of L1 vertebral body. Sagittal T2-weighted spin-echo MR image at same level as B shows low-signal cleft (arrowhead) in L1 vertebral body near superior endplate anteriorly with high signal fluid (arrow) at posterior aspect of cleft.

 


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  		Fig. 2D. —75-year-old man with fracture of L1 vertebral body. Lateral radiograph shows vertebroplasty needle communicating with vacuum cleft. Small amount of contrast material is seen in layers (arrows) in anterior part of cleft.

 


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  		Fig. 2E. —75-year-old man with fracture of L1 vertebral body. Lateral radiograph shows polymethyl methacrylate in vertebral body with small amount passing into T12-L1 and L1-L2 disks. Vertebra has increased height compared with A.

 


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  		Fig. 3A. —84-year-old woman with T12 vertebral body fracture. Sagittal T1-weighted spin-echo MR image shows low-signal cleft (arrow) in vertebral body near superior T12 endplate.

 


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  		Fig. 3B. —84-year-old woman with T12 vertebral body fracture. Sagittal T2-weighted spin-echo MR image shows low-signal cleft (arrows) in vertebral body near superior T12 endplate.

 


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  		Fig. 4A. —84-year-old woman with L2 vertebral body compression fracture showing increased height of body after vertebroplasty. Lateral radiograph obtained at start of vertebroplasty shows horizontal vacuum cleft (arrows) in mid and superior parts of L2 vertebral body. Needle tip is placed near posterior aspect of vertebral body.

 


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  		Fig. 4B. —84-year-old woman with L2 vertebral body compression fracture showing increased height of body after vertebroplasty. Lateral radiograph obtained after early polymethyl methacrylate injection shows opacification of vertebral body inferior to vacuum cleft.

 


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  		Fig. 4C. —84-year-old woman with L2 vertebral body compression fracture showing increased height of body after vertebroplasty. Lateral radiograph obtained after additional polymethyl methacrylate injection shows injected material has entered vacuum cleft. Note increase in height of compressed vertebral body and more parallel orientation of endplates compared with A.

 

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