Procedure Overview

Vertebroplasty Procedure Demonstration (10:40)
Part Number: 9100-900-017 Rev None

We have a T8 compression fracture, the first thing we want to do is line it up in a lateral plane, set up the tower so we can get as true a lateral as we can, squaring the end plates above and below. We see that it’s only mildly compressed but that doesn’t have any correlation with the patient’s debilitating pain. So the next thing we’re going to do is move the tower into the AP plane, look at it in the straight AP. And the vertebral body’s in the straight AP, but as you can see in that picture the pedicles themselves are above the super end plate in this straight AP of this thoracic vertebral body. And then so we will move the tower up and using burrowing in turn we’ll bring the headlights into the grill of the car so now the entire pedicle top to bottom is surrounded by vertebral body. We’ll angle off a little bit to bring vertebral body in on the side of the pedicle as well. So now we can see the entire pedicle is surrounded by vertebral body, on both sides, top and bottom. So if we go down the barrel of that pedicle using this approach there’s nowhere else for our needle to end up than within that vertebral body. So the next thing we’re going to do is anesthetize the skin and the periosteum. Again using the same approach that we’re going to use with our needle, following the angle of the tube and the image intensifier down, we drop right down onto the pedicle, deliver anesthetic directly to the periosteum and again into the track and come on out. Because her pedicles are large enough, we chose an 11-gauge needle. This needle has a little bit different tip. It has what we call a pyramid. What’s important about this tip though is it’s also ground down so the cannula and the trocar are ground together, making the tip very, very easy to direct through bone, even tough bone. It also happens to be an excellent biopsy needle. So, we’ll make a little skin incision. So once again, we’ll take a down-the-barrel approach, we’ll drop our needle down until we hit bone, following the angle between our tube and our image intensifier. Drops right down onto the pedicle. What we’ll do is we’ll take the same approach; we’ll access the pedicle so the needle will stand on its own but not commit it. And now we can address the angle a little bit that we want, continually advancing our needle, trying to take a medial angle so our that our tip will course through the pedicle but end up in the center of the vertebral body. So we’re continually advancing. So we bring the cannula and the trocar anteriorly, accepting the fact that when we pull out the trocar the cannula is not quite as far forward as we thought it was. We’ll now go to a straight AP and see that we’ve approached the midline with our needle so we will accept that position for our cement delivery. So now we’ll take the cement, again taking all the powder, which contains both the monomer and 30% barium, which allows you to pacify the cement, place it all in our mixing device, tap it down. We will take the monomer and bring it in from the sides so it trickles down and involves all of the powder. We’ll then take our mixer, take a deep breath and mix our cement. When we now pull the cement through, you can see that what was powder and liquid, is now a paste pulling though the holes in our mixing device. We’re just trying to get a nice continuous mix of the powder. The plunger comes out and in a reverse turn, on goes our syringe. The syringe is graduated so it lets us know how much cement we’ve delivered. It’s a macro plunger delivering 5cc of cement per turn and then it will crack right now to become a micro plunger, once again, now it’s delivering .1cc per turn as we fill our delivery tube to the end. Take notice of the fact that when we stop injecting, cement does not stop moving through the tube so it’s important if you want to stop the flow of cement you need to release the pressure by back turning on the device. Just dropping it on the table does not stop the flow of cement. So we bring it out, the cement is beginning to achieve the consistency that we want, which is more of a paste as apposed to just a white liquid. Take out our trocar, make sure we like our position, attach our cannula. Slowly, under continuous visualization, we will bring the cement down, appreciating the fact that the needle holds about .7cc of cement so it will take about seven turns to begin to see the flow of cement in the needle as it comes down, which is what we’re seeing right now. We have cement at the needle tip starting to fill the vertebral body, nice and slow. So now we continue to deliver the cement a little bit. Take a look at it in the AP plane just to make sure it’s filling the vertebral body where we want, which it is. Continue to fill and you can see the nice bloom of cement in the vertebral body. The vertebral body is filling back to its posterior half. We’re just at about the midline. We’ll back off a little bit now and check again in the AP plane. You see we’re getting a nice fill of cement on both sides of the midline. We’ll fill a little bit more, again appreciating the fact that we still have .7cc of cement inside our needle that we could choose to deliver. So we’ve achieved a nice deposition of cement in the anterior half of that vertebral body, which is where we want it. We’ve placed about 4cc of cement in, based on our graduated cylinder. And now we will remove the needle. There are several ways that we could remove it. Knowing that we have room in her vertebral body for a little bit more cement to be deposited safely, we’ll plunge the needle, we place our tip in, plunge the needle gently while we’re advancing and delivering that last .7ccs. We see our cannula coming down, the trocar coming down the cannula. And now we’ll remove it. We’ll bring the needle tip to the back of the vertebral body to make sure we are not pulling cement back with us, rotate it once, we see we have a clear avenue, and then we remove the needle, again holding pressure over the back of the pedicle for 20 to 30 seconds to stop the bleeding. We have a nice deposition of cement in this vertebral body and we’ll take some images for posterity.

Vertebroplasty Procedure Animation (:40)
Part Number: 9100-900-017 Rev None

For elderly people, back pain is frequently caused by vertebral compression fractures brought on by osteoporosis or metastatic disease. The vertebral body collapses, causing it to fracture. Percutaneous vertebroplasty is a nonsurgical procedure where a needle is placed into the fractured vertebral body. Using the Stryker Precision System, bone cement is then injected through the needle into the fractured vertebral body, thus stabilizing the fracture and offering structural support.