Imaging guidance prevents complications in vertebroplasty

Demand for percutaneous vertebroplasty may be growing, but radiologists should not be offering the procedure unless they are properly trained and prepared, according to Prof. Afshin Gangi, a professor of radiology at the University Hospital of Strasbourg in France.

At an ECR 2008 foundation course on interventional radiology, Gangi used the interactive session to present a range of potential complications and explain exactly how they could be avoided. He urged audience members who were performing vertebroplasty-or contemplating doing so-to work under the guidance of high-quality x-ray fluoroscopy to ensure real-time feedback on their work.

He recommended that the injection rate should be relatively slow and halted at once should a leak be detected. If the leak persists after 30 seconds, the needle position should be changed. If this doesn't solve the problem, the procedure should be stopped.

When injecting bilaterally, both needles should be positioned and the cement injected before either is removed, Gangi said. Removal of the first needle prior to the second injection can lead to cement rising up the needle track.

Some patients with tumors may be undergoing radiofrequency ablation before vertebroplasty. It is important to allow the treatment area to cool before injecting the cement. Similarly, a minimum 30-minute wait is essential if vertebroplasty is following cryoablation to allow time for the ice ball to melt.

"You should not be aiming to be artistic, but aiming to do a good job. It's a complicated technique, so train and perform," Gangi said.

-By Paula Gould