Seminars in ultrasound, CT, and MR
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Semin. Ultrasound CT MR · Apr 2005
ReviewComplications of percutaneous vertebroplasty and their prevention.
Vertebroplasty is an efficient treatment of vertebral collapses of malignant or benign origin but also carries a risk of complications. Cement extravasation is a frequent occurrence in vertebroplasty. It is well tolerated in the large majority of cases but is also the main source of complications especially nerve root compression in case of cement leakage into the intervertebral foramen and pulmonary embolism of cement complicating venous cement leakage. ⋯ In addition, incidence of new vertebral fractures in adjacent vertebrae may be increased by vertebroplasty. General reactions possibly due to a reflex reaction to intramedullary bone injection and fat embolism may also occur. This article reviews the safety measures to reduce the risk of cement extravasation including high quality permanent radiological guidance enabling early detection of cement extravasation, use of conscious sedation, bilateral transpedicular approach at the thoracic and lumbar levels, careful selection of the bone penetration site in order to make a single vertebral needle path, careful needle placement to avoid the risk of cortical breakthrough, use of a well-opacified and refrigerated cement with a toothpaste consistency.
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Lumbar provocation discography is an invasive diagnostic procedure to identify pain originating from within the lumbar discs. Specific morphological changes within the disc, classified as radial fissures, can be imaged following the injection of radiopaque contrast into the nucleus pulposus. The reproduction of concordant low back and/or referred somatic pain to the lower extremity under controlled conditions and the demonstration of annular radial tears are part of a spectrum of internal disc disruption that is separate from disc degeneration. A review of the validity and technique of lumbar discography as well as recently described causes of false positive responses are presented.