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Midterm Outcome after Vertebroplasty: Predictive Value of Technical and Patient-related Factors¹

¹ From the Mallinckrodt Institute of Radiology, Washington University Medical Center, 510 S Kingshighway Blvd, St Louis, MO 63110-1076. From the 2001 RSNA scientific assembly. Received November 23, 2001; revision requested February 12, 2002; final revision received October 28; accepted October 31. Address correspondence to L.A.G. (e-mail: gilulal@mir.wustl.edu).

View larger version (16K): [in a new window]   Figure 1. Diagram shows grading of leakage. Minor (grade 1) leakage: longest diameter of the extravertebral PMMA collection less than the longest diameter of the closest pedicle. Moderate (grade 2) leakage: longest diameter of the extravertebral PMMA greater than the longest diameter of the closest pedicle but less than the craniocaudal diameter of the nearest normal vertebral body.

View larger version (113K): [in a new window]   Figure 2. Lateral fluoroscopic image shows injection into T10 in a 66-year-old woman with osteoporosis. The left side of the image is posterior. Note moderate intradiskal leakage (arrows).

View larger version (108K): [in a new window]   Figure 3a. (a) Lateral and (b) right posterolateral oblique fluoroscopic images show injection into L1 in a 77-year-old woman with osteoporosis. Note minimal intradiskal (white arrows) and moderate paravertebral (black arrows in a) leakage.

View larger version (98K): [in a new window]   Figure 3b. (a) Lateral and (b) right posterolateral oblique fluoroscopic images show injection into L1 in a 77-year-old woman with osteoporosis. Note minimal intradiskal (white arrows) and moderate paravertebral (black arrows in a) leakage.

View larger version (134K): [in a new window]   Figure 4a. (a) Posteroanterior and (b) lateral fluoroscopic images show injection into L1 in a 83-year-old woman with metastasis that originated from carcinoma of the breast. Note moderate epidural leakage (arrows). PMMA is shown escaping into epidural veins in b (arrowheads).

View larger version (139K): [in a new window]   Figure 4b. (a) Posteroanterior and (b) lateral fluoroscopic images show injection into L1 in a 83-year-old woman with metastasis that originated from carcinoma of the breast. Note moderate epidural leakage (arrows). PMMA is shown escaping into epidural veins in b (arrowheads).

View larger version (124K): [in a new window]   Figure 5a. (a) Posteroanterior and (b) lateral fluoroscopic images show injections into L3 and L4 in a 63-year-old woman with osteoporosis. Note moderate posterolateral (extraforaminal) leakage (arrows). In addition, PMMA is seen in the posterolateral veins (arrowheads).

View larger version (129K): [in a new window]   Figure 5b. (a) Posteroanterior and (b) lateral fluoroscopic images show injections into L3 and L4 in a 63-year-old woman with osteoporosis. Note moderate posterolateral (extraforaminal) leakage (arrows). In addition, PMMA is seen in the posterolateral veins (arrowheads).

View larger version (117K): [in a new window]   Figure 6a. (a) Posteroanterior and (b) lateral radiographs in a 55-year-old woman with osteoporosis. Needle is shown within T12. PMMA is present from a preceding vertebroplasty session at L1 and is just visible at the L2 level. Note moderate lateral paravertebral leakage on the right (arrows in a). There is no extension into the posterolateral (foraminal) region, as shown in b.

View larger version (106K): [in a new window]   Figure 6b. (a) Posteroanterior and (b) lateral radiographs in a 55-year-old woman with osteoporosis. Needle is shown within T12. PMMA is present from a preceding vertebroplasty session at L1 and is just visible at the L2 level. Note moderate lateral paravertebral leakage on the right (arrows in a). There is no extension into the posterolateral (foraminal) region, as shown in b.