Accuracy of vertebral puncture in percutaneous vertebroplasty

Abstract

Purpose To clarify the accuracy of vertebral puncture of the vertebral tertile area needling (VETERAN) method puncturing the pedicle superimposed on one-third of the width between the lateral vertebral line to the contralateral medial lamina line compared with Cathelin-needle-assisted puncture (CAP) method puncturing using the Cathelin needle as a guide in percutaneous vertebroplasty. Materials and methods 449 punctures by CAP method and 125 punctures by VETERAN method were enrolled. We compared the puncture accuracy of both methods. We estimated a vertebral estimated tilting ratio (VET-ratio) defined as ratio of the distance between the lateral vertebral line and the contralateral medial laminal line to the distance between the vertebral lateral line and the puncture point measured by computed tomography. We also estimated the procedural items and clinical outcomes. Results VETERAN method with 100% of punctures within safe zone (cortical breaches within 2 mm) had significantly higher accuracy than CAP method with 97.8% (p < 0.01) for the 2 mm incremental evaluation. No cases with a VET-ratio of 36% or less had cortical breaches. VETERAN method had shorter operative time per puncture (p < 0.01) and exposure time per puncture (p < 0.05). Conclusion VETERAN method reduced the occurrence of the inaccurate puncture, operative times, and exposure times. A VET-ratio with 36% or less is associated with a safe puncture using VETERAN method.

Current status and challenges of percutaneous vertebroplasty (PVP)

“…Transient hypotension due to suspected vagal reflex [49] 1.0% Myocardial infarction [69] 0.05% Paraplegia/Paraparesis Paraplegia [59-61, 89, 90, 94] < 1% Paraparesis [59] 0.75% Nerve root symptoms [59] 0.75% Vessel damage and bleeding [53,54,[57][58][59][60][61] < 1% Paraparesis due to intracanal subdural hematoma [59] 0.5% Infection after PVP [69,72,74,75] 0.1-0.46% Allergy to PMMA [42][43][44] < 1% Puncture in the spinal canal [56] 0.8-4.0% Vertebral refracture after PVP Refracture in adjacent or remote vertebra [3,24,48,49,69] 4.9-19% Refracture in treated vertebra [81][82][83] 0.56-3.2% Fractures other than vertebral fractures related to PVP [3,23,80] 1.1-2.6% Cerebral infarction [84] one case report Fat embolism [85,86] two case reports can contribute to sustained pain and even a worsening of his or her quality of life [25,26]. Self-assessment indices should be used only as a reference when deciding on the indications for PVP and patient monitoring after PVP.…”

“…It must be acknowledged that like essentially every medical procedure, PVP is not perfectly safe [3,24,[48][49][50][51][52]. Adverse events of PVP include damage to the spinal cord and thoracoabdominal organs or bleeding due to inappropriate puncture needle insertion [53][54][55][56][57][58][59][60][61], compression or damage to the spinal cord or nerve roots, venous thrombosis, or cardiopulmonary cement embolization due to leakage of bone cement outside the vertebral body [3, 24, 42-44, 48, 49, 51, 55, 59, 62-70], sudden reduction in blood pressure and shock symptoms due to allergic reactions [42][43][44], infection due to a non-sterile operation [69,[71][72][73][74][75], vertebral refractures or fractures other than in a vertebra [3,23,24,48,49,69,[76][77][78][79][80][81][82][83], and the other rare but serious complications [49,69,80,[84]…”

“…The rate of a puncture-needle penetration into the spinal canal during PVP is 0.8–4.0% [ 56 ]. All of the reported patients with a puncture-needle penetration into the spinal canal were asymptomatic with conservative treatment of extended postoperative resting time and follow-up by imaging examinations.…”