Patient Preparation

Following the informed consent process, the patient is taken to the radiology suite. Often patients are reluctant to lie prone on the table, and 20-50 ^g of fentanyl (Sublimaze, Abbott Labs, North Chicago, IL) 5 min prior to positioning may be helpful. The patient is then placed prone on the procedure table, and physiological monitors including electrocardiogram (EKG) leads, blood pressure cuff, and pulse oximeter are attached. Oxygen via nasal cannula is recommended as patients may have difficulty breathing in this position. The vast majority of vertebro-plasty cases can be performed with conscious sedation, usually small doses of fentanyl and midazolam (Versed, Roche Pharma, Manati, Puerto Rico). General anesthesia would be considered in patients with compromised pulmonary function or those in extreme pain who are unable to lie in the prone position for any period of time.

T10 Vertebral BodyT10 Vertebral Compression FractureVertebral Body

Fig. 1. (A-C) Elderly woman with chronic obstructive pulmonary disease and severe osteoporosis. PA (A) and lateral (B) chest plain films show multiple thoracic vertebral compression fractures from T4 to T12, of indeterminate age. The patient's pain was difficult to localize. Anterior and posterior bone scan (C) shows intense uptake of radionuclide in T9 and T10, with significant uptake in T11 and T12. Following vertebroplasty of these four levels, the patient described marked relief of her pain.

Fig. 1. (A-C) Elderly woman with chronic obstructive pulmonary disease and severe osteoporosis. PA (A) and lateral (B) chest plain films show multiple thoracic vertebral compression fractures from T4 to T12, of indeterminate age. The patient's pain was difficult to localize. Anterior and posterior bone scan (C) shows intense uptake of radionuclide in T9 and T10, with significant uptake in T11 and T12. Following vertebroplasty of these four levels, the patient described marked relief of her pain.

Images Compression Fracture

Fig. 2. (A-C) Middle-aged man with osteoporosis secondary to steroid use and a new T5 compression fracture. T1-WI (A), T2-WI (B), and STIR (C) sagittal imaging was performed. Although the fracture edema is seen on all three sequences, it is most easily detected on the STIR image as a high signal intensity involving the entire vertebral body (arrows).

Fig. 2. (A-C) Middle-aged man with osteoporosis secondary to steroid use and a new T5 compression fracture. T1-WI (A), T2-WI (B), and STIR (C) sagittal imaging was performed. Although the fracture edema is seen on all three sequences, it is most easily detected on the STIR image as a high signal intensity involving the entire vertebral body (arrows).

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