An Overview of Vertebroplasty: Current Status, Controversies, and Future Directions Rikin Hargunani, BSc, MBBS, MRCS, FRCR, Thomas Le Corroller, MD, MSc,

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An Overview of Vertebroplasty: Current Status, Controversies, and Future Directions Rikin Hargunani, BSc, MBBS, MRCS, FRCR, Thomas Le Corroller, MD, MSc, Khalid Khashoggi, MBBS, FRCPC, David M. Liu, MD, FRCPC, ABR(D), CAQ(IR), Laurel O. Marchinkow, RTR, Michael J. Mudri, BA, AIT, Kieran P. Murphy, MB, FRCPC, FSIR, Hugue A. Ouellette, MD, FRCPC, Peter L. Munk, MD, CM, FRCPC, FSIR Canadian Association of Radiologists Journal Volume 63, Issue 3, Pages S11-S17 (August 2012) DOI: 10.1016/j.carj.2012.04.001 Copyright © 2012 Canadian Association of Radiologists Terms and Conditions

Figure 1 Sagittal computed tomography reformatted images, demonstrating a vertebra plana before treatment (A) and after treatment with vertebroplasty (B). Canadian Association of Radiologists Journal 2012 63, S11-S17DOI: (10.1016/j.carj.2012.04.001) Copyright © 2012 Canadian Association of Radiologists Terms and Conditions

Figure 2 (A) Pictorial representation of the vertebral body, demonstrating the site of needle access in transpedicular vertebroplasty. Line diagrams, depicting needle placement via the upper outer quadrant of the pedicle (B), which is then advanced into the vertebral body (C). Lateral fluoroscopic (D) and anteroposterior fluoroscopic (E) views, demonstrating optimal placement of a single needle within the vertebral body at the junction of anterior fourth and posterior three-fourths near the midline (C). This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2012 63, S11-S17DOI: (10.1016/j.carj.2012.04.001) Copyright © 2012 Canadian Association of Radiologists Terms and Conditions

Figure 3 Postvertebroplasty sagittal computed tomography–reformatted image, demonstrating optimal distribution of cement within the anterior aspect of the vertebral body, extending from approximately the top to the bottom of the vertebra. Canadian Association of Radiologists Journal 2012 63, S11-S17DOI: (10.1016/j.carj.2012.04.001) Copyright © 2012 Canadian Association of Radiologists Terms and Conditions

Figure 4 Lateral fluoroscopic view (A) and sagittal computed tomography–reformatted image (B), demonstrating small and asymptomatic disk leaks (arrowheads) through the superior and inferior endplates of L2, in a 43-year-old patient with breast metastasis treated by vertebroplasty. Canadian Association of Radiologists Journal 2012 63, S11-S17DOI: (10.1016/j.carj.2012.04.001) Copyright © 2012 Canadian Association of Radiologists Terms and Conditions

Figure 5 Lateral fluoroscopic image (A), demonstrating early paravertebral vein opacification anterior to the vertebral body (arrowheads). Injection was immediately suspended, which resulted in a clinically insignificant confined leak (arrowhead), as confirmed on posttreatment computed tomography (B). Canadian Association of Radiologists Journal 2012 63, S11-S17DOI: (10.1016/j.carj.2012.04.001) Copyright © 2012 Canadian Association of Radiologists Terms and Conditions

Figure 6 Preoperative sagittal T1-weighted (A) and postcontrast T1-weighted (B) magnetic resonance (MR) images, showing bone marrow replacement of L4 and L5 vertebral bodies in a 39-year-old patient with breast carcinoma metastases. (C) An anteroposterior fluoroscopic view of L5, demonstrating the position of the radiofrequency probe (arrow) in the vertebral body. Sagittal computed tomography–reformatted image (D), exhibiting the cement distribution within the vertebral bodies of L4 and L5 immediately after combined radiofrequency ablation and cementoplasty. Sagittal T1-weighted (E) and postcontrast T1-weighted (F) MR images obtained 4 weeks after treatment, demonstrating low signal changes (asterisks) in the radiofrequency and cementoplasty zone in L4 and L5. Canadian Association of Radiologists Journal 2012 63, S11-S17DOI: (10.1016/j.carj.2012.04.001) Copyright © 2012 Canadian Association of Radiologists Terms and Conditions