Value of the vertebrogram in predicting cement filling patterns with unipedicular percutaneous vertebroplasty

Abstract

Background: Unipedicular vertebroplasty can be successful in selected patients to decrease procedure time, sedation amounts, and cost. Purpose: To evaluate the value of the antecedent unipedicular vertebrogram in predicting patterns of cement deposition to decide whether unipedicular vertebroplasty will be successful, or if a bipedicular vertebroplasty is needed. Material and Methods: 75 fractured vertebral levels were injected by a unipedicle approach with iodinated contrast material (vertebrogram). This filling pattern was then compared to the cement deposition pattern, via the same pedicle, of the percutaneous vertebroplasty. Results: 35 levels showed excellent cross-filling and matched pattern by vertebrogram and cement deposition (47%). Twelve levels (16%) showed cross-filling by both techniques, with less than 100% matched pattern, but cement deposition was considered adequate for fracture treatment. Four levels (5%) showed predominantly matched central filling, considered adequate for fracture treatment. Twenty-one levels (28%) showed only matched filling of half of the vertebral body with both techniques, necessitating a bipedicle approach for treatment with cement. The remaining three levels (4%) demonstrated mismatched patterns between the vertebrogram and the cement deposition, necessitating a bipedicular approach. Conclusion: The unipedicular vertebrogram was helpful in predicting adequate cement deposition, using a single pedicle, in 51 of 75 cases (68%). The vertebrogram was also accurate in predicting the need for a double-pedicle technique in an additional 21 cases (28%). Therefore, the vertebrogram was very helpful in predicting the route of cement deposition in 72 of 75 (96%) cases, and should be considered as an adjunct to percutaneous vertebroplasty.