KEY FACTS Terminology Percutaneous stabilization of sacral fracture via bone cement injection Preprocedure Indications Insufficiency fracture Pathologic fracture Posttraumatic fracture Laboratory data Coagulation parameters Infection/inflammation markers Imaging Consistent with acute/subacute fracture Look for retropulsion of bone fragments into sacral canal…
KEY FACTS Terminology Vertebral fracture reduction via bipedicular balloon inflation followed by polymethylmethacrylate (PMMA) cement augmentation Preprocedure Carefully determine correct level STIR MR is most sensitive for vertebral edema Ensure level of pain is consistent with acutely fractured vertebra on…
KEY FACTS Terminology Percutaneous cement augmentation of vertebral body Preprocedure STIR MR provides excellent depiction of bone marrow edema in acute fracture Clinical examination Consistent with imaging findings Point tenderness should be assessed prior to sedation Procedure Can be performed…
KEY FACTS Terminology Corticosteroid/anesthetic injection into lumbar epidural space via interlaminar, transforaminal, or caudal approach Preprocedure Indications Lumbar radiculopathy Residual pain following vertebroplasty/kyphoplasty Things to check Prior imaging: Adequate epidural space (especially important in postoperative back!) Avoid interlaminar approach in…
KEY FACTS Terminology Selective corticosteroid and long-acting anesthetic injection of lumbar nerve root at level of neural foramen Preprocedure Imaging Single or multilevel involvement Procedure Carefully determine correct level(s) for injection Nerve root exits below pedicle of same numbered vertebral…
KEY FACTS Terminology Injection of corticosteroid and anesthetic into lumbar facet joint Preprocedure Facet joint osteoarthritis Synovial cyst causing neurologic symptoms Procedure Prone Angle C-arm or PA fluoroscopy tube slightly toward side of joint to be injected Generally, lower 1/3…
KEY FACTS Terminology Selective anesthesia of lumbar nerve medial branch in diagnostic evaluation of lumbar facet joint pain Preprocedure Facet joint pain Useful in selecting patients for medial branch radiofrequency ablation procedure Procedure Target: Junction of superior articular process and…
KEY FACTS Terminology Injection of glucocorticoid/long-acting anesthetic into thoracic epidural space via interlaminar or transforaminal approach Procedure Interlaminar epidural steroid injection (ESI) Define margins of lamina and interlaminar space Transforaminal ESI Ensure good visualization of neural foramen on true lateral…
KEY FACTS Terminology Selective corticosteroid and long-acting anesthetic injection of thoracic nerve root at level of neural foramen Preprocedure Indications Thoracic radiculopathy Persistent pain after vertebroplasty/kyphoplasty Neoplastic compression of thoracic nerve root Procedure Use nonparticulate steroid to minimize vascular risk…
KEY FACTS Terminology Injection of long-acting anesthetic ± corticosteroid into thoracic facet joint Preprocedure Preprocedure imaging Correlate level with prior imaging – Evaluate for 12 ribs &/or transitional vertebral anatomy Indications for procedure and future treatment plan Is facet joint…