What is the approach to needle placement for percutaneous vertebroplasty (PVP)?

Updated: Nov 12, 2019
  • Author: Gaurav Gupta, MD; Chief Editor: Justin A Siegal, MD  more...
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Answer

Answer

Lidocaine with epinephrine is commonly used for local anesthetic and a spinal needle to anesthetize the periosteum. Proper trajectory may be confirmed with AP and lateral fluoroscopic views. Depending on the size of the pedicle, different gauge needles can be used. 11-gauge is recommended for lumbar and lower thoracic pedicles; but a 13-gauge will suffice midthoracic pedicles.

A large clamp will allow for maintenance of tension along the back to allow for easier placement of the needle. A sterile hammer can be used to gently tap the needle. Direct the needle into the vertebral body, using AP and lateral views for verification.

Percutaneous vertebroplasty, transpedicular approa Percutaneous vertebroplasty, transpedicular approach.
Percutaneous vertebroplasty, transpedicular approa Percutaneous vertebroplasty, transpedicular approach under fluoroscopic guidance, lateral view.
Percutaneous vertebroplasty, transpedicular approa Percutaneous vertebroplasty, transpedicular approach under fluoroscopic guidance, anteroposterior view.

Transpedicular approaches:

  • For a unipedicular approach, advance needle into the anterior third of the central vertebral body.

  • For a bipedicular approach, advance needles into the midportion of the hemivertebrae.

  • A parapedicular approach may be considered as well.


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