Percutaneous vertebroplasty with the rotational fluoroscopy imaging technique.

OBJECTIVE: To evaluate the feasibility of the rotational angiography unit (RAU) as a single technique to guide percutaneous vertebroplasty (PVP).
MATERIALS AND METHODS: Twenty-five consecutive patients (35 vertebral bodies, 20 lumbar and 15 thoracic) were treated using RA fluoroscopy. Using a state-of-the-art flat-panel angiographer (Artis zee, Siemens, Erlangen, Germany), rotational acquisitions were obtained in all patients for immediate post-procedure 2D/3D reconstructions. Pre- and postoperative back pain was assessed with the visual analog scale (VAS). Fluoroscopy time, patient radiation dose exposure, technical success, mean procedure time, mean number of rotational acquisitions and procedural complications were recorded. All features were compared with a historical cohort of patients (N = 25) who underwent PVP under CT and mobile C-arm fluoroscopy guidance.
RESULTS: In all cases, safe and accurate control of the needle insertion and bone-cement injection was successfully obtained with high-quality fluoroscopy images. One cement leakage was detected in the RAU group, and two leakages were detected in the CT and C-arm fluoroscopy group. Technical features were significantly different between the two groups (RAU vs. CT): mean procedure time: 38.2 min vs. 60.2 min (p = 0.02); median fluoroscopy time: 14.58 and 4.58 min (p = 0.02); median number of rotational acquisitions: 5 vs. 10 (p = 0.02); mean patient dose: 6 ± 1.3 mSv vs. 23 ± 1.3 mSv (p = 0.02). There were minor complications (pain, small hematoma) in two patients (8%) in the study group and three cases (12%) in the control group.
CONCLUSION: RAU guidance is an effective and safe technique for performing PVP because it reduces the procedural time and radiation exposure.