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Puncture
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After positioning the patient, under neuroleptanalgesia and local anesthesia, a 10- or 15-gauge bevel-edgde needle is introduced into the vertebral body. Different approach routes can be selected : the anterior route for cervical level, the transpedicular and intercostovertebral route for the thoracic level, the posterolateral and the transpedicular route for the lumbar level.
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The needle is guided safely under CT. Cortical perforation requires the aid of a surgical hammer. When the needle is in the optimal position (needle tip in the anterior third of the vertebral body), the imaging mode is switched to fluoroscopy.
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Vascular Interventions
Puncture
