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* Date : 06-08-2009 - 07:48 PM (5429 days ago), * Characters : 1931, Words : 283, Size : 1.89 Kb.

Percutaneous Sacroplasty using CT Fluoroscopy.

At our institution, we have had significant experience with percutaneous vertebroplasty by using fluoroscopic guidance. Our experience with sacroplasty, however, has been limited, and reports describing the technical performance of sacroplasty are limited. Sacral insufficiency fractures generally involve the sacral ala, and there is a limited amount of trabecular bone to accept the vertebroplasty cement. The surface anatomy of the posterior sacrum is widely variable, and it can be difficult to confirm exact needle placement under standard fluoroscopy. During cement injection, the relationship between the cement and sacral foramina can be difficult to ascertain because of the oblique configuration of the sacrum and foramina. Also, fluoroscopic visualization can be difficult in the pelvic region particularly in the lateral projection because of radiography penetration issues. Because the injected cement is superimposed on the needle tip during fluoroscopic injection, it can also be difficult to determine whether cement is extravasating into the soft tissues immediately adjacent to the sacrum.

Because of our success with this case, we have elected to use the CT fluoroscopy technique described above in all of our sacroplasty procedures. The use of CT fluoroscopy allows for combined needle placement and cement injection without the need to move the patient. Furthermore, the precise control of cement placement can be monitored in the axial plane and followed in the cranial caudal direction with swift CT table repositioning and prompt CT fluoroscopic image acquisition. Although some investigators have found CT fluoroscopy makes it difficult to evaluate the injection of cement in the craniocaudal dimension, we have not encountered such limitations.7 By selecting an appropriate section thickness and area of coverage, we are able to confidently assess the distribution of cement in the craniocaudal plane.

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