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Technique overview
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The procedure is performed under local anesthesia usually combined with neuroleptanalgesia. The patient is placed in prone position for lumbar level and in supine position for cervical level. A 15-gauge needle is used in cervical level, a 10-gauge needle in thoracic and lombar level. We always use dual guidance : CT and C-arm fluoroscopy. The entry point and the pathway are determined by CT, avoiding the nerve root and visceral structures.The needle is safely guided under CT.
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Once the needle is in the optimal position, the imaging mode is switched to fluoroscopy. The acrylic cement mixed with tantalum (to increase radio-opacity) has to be injected during its pasty polymerization phase to prevent distal venous migration. The injection of glue is carefully controlled under strict lateral fluoroscopy. The injection of glue is stopped whenever an epidural or paravertebral opacification is observed. | |
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Vascular Interventions
Overview