Percutaneous Vertebroplasty in Patients with Spinal Canal Compromise
Noah B. Appel1,2 and
Louis A. Gilula3
1 Mallinckrodt Institute of Radiology, Section of Interventional Radiology,
Washington University Medical Center, St. Louis, MO 63110-1076.
2 Present address: Dallas Radiologists, P.A., 7515 Greenville Ave., Ste. 710,
Dallas, TX 75231-3848.
3 Mallinckrodt Institute of Radiology, Section of Musculoskeletal Radiology,
Washington University Medical Center, 510 S Kingshighway Blvd., St. Louis, MO
63110-1076.
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Fig. 1A. —Graphics show classification of spinal canal (or spinal cord)
compromise (axial representation). Graphic shows normal classification.
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Fig. 1B. —Graphics show classification of spinal canal (or spinal cord)
compromise (axial representation). Graphic shows category 1 classification:
loss of ventral epidural space with no spinal cord deformity.
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Fig. 1C. —Graphics show classification of spinal canal (or spinal cord)
compromise (axial representation). Graphic shows category 2 classification:
spinal cord deformity but no abnormal cord signal on T2-weighted images.
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Fig. 1D. —Graphics show classification of spinal canal (or spinal cord)
compromise (axial representation). Graphic shows category 3 classification:
cord deformity with increased signal within cord on T2-weighted images.
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Fig. 2A. —83-year-old woman with metastatic carcinoma. Axial (TR/TE,
1,785/110) (A) and sagittal (4,400/110) (B) T2-weighted images
show category 2 lesion with deformation of spinal cord at T9 level.
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Fig. 2B. —83-year-old woman with metastatic carcinoma. Axial (TR/TE,
1,785/110) (A) and sagittal (4,400/110) (B) T2-weighted images
show category 2 lesion with deformation of spinal cord at T9 level.
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Fig. 3A. —84-year-old woman with osteoporotic compression fracture.
Axial (TR/TE, 6,610/112) (A) and sagittal (6,517/130) (B)
T2-weighted images of category 2 lesion show spinal cord deformity without
abnormal spinal cord signal at T12.
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Fig. 3B. —84-year-old woman with osteoporotic compression fracture.
Axial (TR/TE, 6,610/112) (A) and sagittal (6,517/130) (B)
T2-weighted images of category 2 lesion show spinal cord deformity without
abnormal spinal cord signal at T12.
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Fig. 4A. —51-year-old woman with multiple myeloma. Axial (TR/TE,
5,565/112) (A) and sagittal (5,664/112) (B) T2-weighted images
of category 3 lesion. At T11 level, spinal cord is deformed with increased
signal (arrow, A and arrowheads, B) within
cord itself.
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Fig. 4B. —51-year-old woman with multiple myeloma. Axial (TR/TE,
5,565/112) (A) and sagittal (5,664/112) (B) T2-weighted images
of category 3 lesion. At T11 level, spinal cord is deformed with increased
signal (arrow, A and arrowheads, B) within
cord itself.
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Fig. 5A. —Examples of polymethylmethacrylate leakage seen on
fluoroscopic spot radiographs. Patients experienced no complications related
to leakage of polymethylmethacrylate mixture. Frontal (A) and lateral
(B) radiographs of 84-year-old woman with osteoporatic compression
fracture (same patient as in Fig.
3A,
3B) with needles placed into
adjacent segments at T12 and L1 led to polymethylmethacrylate pasing through
intervening disk (A), anteriorly to form bridge (A and B)
between these two segments. This patient had preprocedure pain score
(lowest–highest, 0–10) of 8, postprocedural score of 0, and was
"better" at 6-month follow-up.
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Fig. 5B. —Examples of polymethylmethacrylate leakage seen on
fluoroscopic spot radiographs. Patients experienced no complications related
to leakage of polymethylmethacrylate mixture. Frontal (A) and lateral
(B) radiographs of 84-year-old woman with osteoporatic compression
fracture (same patient as in Fig.
3A,
3B) with needles placed into
adjacent segments at T12 and L1 led to polymethylmethacrylate pasing through
intervening disk (A), anteriorly to form bridge (A and B)
between these two segments. This patient had preprocedure pain score
(lowest–highest, 0–10) of 8, postprocedural score of 0, and was
"better" at 6-month follow-up.
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Fig. 5C. —Examples of polymethylmethacrylate leakage seen on
fluoroscopic spot radiographs. Patients experienced no complications related
to leakage of polymethylmethacrylate mixture. Frontal (C) and lateral
(D) spot radiographs of 51-year-old woman (same patient as in Fig.
4A,
4B) with small amount of
paravertebral leakage present bilaterally. This patient had preprocedural pain
score (lowest–highest, 0–10) of 7, immediate postprocedural score
of 3.5, and was "better" at 3-month follow-up and
"same" at 6-month follow-up.
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Fig. 5D. —Examples of polymethylmethacrylate leakage seen on
fluoroscopic spot radiographs. Patients experienced no complications related
to leakage of polymethylmethacrylate mixture. Frontal (C) and lateral
(D) spot radiographs of 51-year-old woman (same patient as in Fig.
4A,
4B) with small amount of
paravertebral leakage present bilaterally. This patient had preprocedural pain
score (lowest–highest, 0–10) of 7, immediate postprocedural score
of 3.5, and was "better" at 3-month follow-up and
"same" at 6-month follow-up.
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Copyright © 2004 by the American Roentgen Ray Society.
