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Vertebral fracture reduction via bipedicular balloon inflation followed by polymethylmethacrylate (PMMA) cement augmentation
Carefully determine correct level
STIR MR is most sensitive for vertebral edema
Ensure level of pain is consistent with acutely fractured vertebra on imaging
Angle C-arm toward side of pedicle to be accessed
Must have clear view of pedicle cortex
Lateral fluoroscopy is essential in determining needle depth
Needle tip in vertebra should allow inflated balloon to be centrally placed in hemivertebra
Sudden decrease in pressure and heterogeneous contrast extravasation indicates balloon rupture
Expectation: Significant decrease in pain following procedure
Some patients will develop periprocedural pain requiring narcotics ± muscle relaxants
Problems: Fracture at additional/adjacent levels
Risk appears increased with PMMA cement extravasation into disc space
Most feared complications
Spinal cord puncture during needle placement
Spinal cord compression by hematoma or cement extravasation
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