Percutaneous cementoplasty involves injecting acrylic cement into vertebral bodies to prevent collapse and relieve pain in patients with pathologic or compressed vertebrae. It can be used to treat osteoporotic fractures, tumors, and metastases. The procedure is performed under local anesthesia and fluoroscopy guidance. Cement is injected during its viscous phase to prevent leaks. Potential complications include cement leaks into the epidural space, veins, or disk, which can cause cord compression or embolism. The procedure provides pain relief but risks include leak-related complications and infection.

1. DR ASHISH K. GUPTA
PG 2ND YEAR
RADIODIAGNOSIS
SLIMS

2. Introduction
 Percutaneous cementoplasty (also known
as vertebral packing or vertebroplasty)
 with acrylic cement
(polymethylmethacrylate [PMMA])
 A procedure aimed at preventing vertebral
body collapse and pain in patients with
pathologic vertebral bodies.
 Percutaneous cementoplasty is a
promising therapeutic technique for pain
control in patients with bone failure

3. Vertebral puncture via the posterolateral
route and vertebral filling.

4. Vertebral puncture via the posterolateral
route and vertebral filling.

5. Applications
 It can be used in the treatment of:
 Severe painful osteoporosis with loss of
height and/or with compression fractures of
vertebral bodies
 Insufficiency fracture
 Aggressive hemangioma
 Vertebral multiple myeloma
 Painful vertebral body tumors and acetabular
tumors
 Vertebral metastases

6. Acute L2 vertebral compressive
fracture

7. Multiple myeloma

8. Multiple myeloma

9. Contraindications
• Hemorrhagic diathesis.
• Infection.
• Lesions with epidural extension. These
require careful injection to prevent epidural
overflow and spinal cord compression by the
cement or displaced epidural tissue.

10. Procedure
 The procedure is performed with the patient under local
anesthesia usually combined with neuroleptanalgesia.
 The patient is placed in the prone position for the lumbar
and thoracic levels and in the supine position for the
cervical level.
 A 15-gauge needle is used for cervical vertebrae and a
10-gauge needle for thoracic and lumbar vertebrae.
 The entry point and the pathway, avoiding the nerve root
and visceral structures, are determined with CT.
 The needle is safely guided under CT or biplane
fluoroscopy.

11. Procedure
 Once the needle is in the optimal position, the
imaging mode is switched to fluoroscopy.
 The acrylic cement mixed with tantalum (to
increase radiopacity) has to be injected during
its pasty polymerization phase to prevent distal
venous migration .
 The injection of cement is carefully controlled
under strict lateral fluoroscopy.
 The injection of cement is stopped whenever
epidural or paravertebral opacification is
observed or when the cement reaches the
dorsal quarter of the vertebral body.

12. Sagittal view demonstrates percutaneous
cementoplasty and vertebral filling

13. Percutaneous Vertebroplasty

14. Percutaneous Vertebroplasty

15. Percutaneous Vertebroplasty

16. Percutaneous Vertebroplasty

17. Complications
•. The most serious complication is a cement leak.
•. The second most serious complication is
infection. Strict sterility during the intervention is
mandatory.
•. Temporary pain can occur after the procedure.
Patients are usually free of pain after 24 hours..
•. Allergic reactions and hypertension are limited in
these procedures because the quantity of
cement injected in percutaneous cementoplasty
is far less than that used in orthopedic surgery.

18. Cement Leaks
•. Cement leaks toward the epidural veins,
epidural space, and neural foramina can
occur. The most serious complication during
cement injection is epidural overflow of
PMMA with spinal cord compression.
•. Cement leaks toward the disk usually do not
have clinical consequence; however, these
leaks may increase the risk of adjacent
vertebral collapse.

19. Leak into paravertebral veins can lead to
pulmonary cement embolism. To avoid
major pulmonary infarction, the cement
should be injected slowly under
fluoroscopic control during its pasty
polymerization phase, and the injection
should be immediately stopped if a
venous leak is observed.
•. Cement leaks into paravertebral soft
tissues have no clinical significance.

20. Leaks in the (a) axial
and (b) sagittal plane

21. Fluoroscopy show leaks toward the
disk

22. CT scans show leaks toward the
disk.

23. Extravasation into paravertebral
veins

24. fluoroscopy show venous
leaks.

25. Extravasation into paravertebral
veins

26. CT scans show venous leaks.

27. CT scans show venous leaks

28. Pulmonary cement
embolism PA, LAT

29. CT scans show pulmonary cement
embolisms (arrows).

30. CT scans show pulmonary cement
embolisms (arrows).

31. CT scans show epidural space
leaks.

32. CT scans show epidural space
leaks.

33. Thank you