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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleSpine Imaging and Spine Image-Guided Interventions

Single-Needle Lateral Sacroplasty Technique

P.J. Nicholson, C.A. Hilditch, W. Brinjikji, A.C.O. Tsang and R. Smith
American Journal of Neuroradiology November 2018, DOI: https://doi.org/10.3174/ajnr.A5884
P.J. Nicholson
aFrom the Division of Neuroradiology (P.J.N., C.A.H., W.B., A.C.O.T., R.S.), Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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C.A. Hilditch
aFrom the Division of Neuroradiology (P.J.N., C.A.H., W.B., A.C.O.T., R.S.), Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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W. Brinjikji
aFrom the Division of Neuroradiology (P.J.N., C.A.H., W.B., A.C.O.T., R.S.), Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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A.C.O. Tsang
aFrom the Division of Neuroradiology (P.J.N., C.A.H., W.B., A.C.O.T., R.S.), Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
bDivision of Neurosurgery (A.C.O.T.), Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong.
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R. Smith
aFrom the Division of Neuroradiology (P.J.N., C.A.H., W.B., A.C.O.T., R.S.), Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Figures

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  • Fig 1.
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    Fig 1.

    Posteroanterior fluoroscopic image showing the 11-ga needle inserted via the left sacral ala in a transiliac approach.

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    Fig 2.

    Lateral fluoroscopic image showing the same needle inserted into S1, positioned within the intramedullary cavity between the anterior and posterior cortices of the bone. Note an osteophyte anterior to the anterior margin of the sacrum (white arrow).

  • Fig 3.
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    Fig 3.

    Posteroanterior fluoroscopic image showing the needle having been withdrawn in a transiliac fashion along its insertion path, injecting aliquots of cement as it is withdrawn.

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    Fig 4.

    Lateral fluoroscopic image following needle withdrawal showing the polymethylmethacrylate cement confined to the sacral cortex.

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    Fig 5.

    Axial reconstruction from a postoperative CT scan showing the cement well-positioned within the intramedullary cavity of the sacrum.

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    Fig 6.

    Coronal reconstruction from a postoperative CT scan showing the cement well-positioned within the intramedullary cavity of the sacrum.

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    Fig 7.

    Illustration of the correct needle trajectory showing the needle path and method of cement deposition in the anteroposterior plane.

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    Fig 8.

    Illustration of the correct needle trajectory showing the needle path and method of cement deposition in the lateral plane.

Tables

  • Figures
  • Patient details and outcome data

    SexAge (yr)Cement Volume Injected (mL)Primary DiseasePain Preprocedure (VAS)Pain 1 Month Postprocedure (VAS)
    Female3614Breast carcinoma40
    Male5911Myeloma72
    Female6212Non-small cell lung carcinoma70
    Male6625Myeloma50
    Male8610Osteoporosis70
    Female6910Osteoporosis106
    Female6910Breast carcinoma84
    Female7711Osteoporosis73
    Female7511Myeloma70
    Male768Non-small cell lung carcinoma80
    • Note:—VAS indicates Visual Analog Scale.

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Cite this article
P.J. Nicholson, C.A. Hilditch, W. Brinjikji, A.C.O. Tsang, R. Smith
Single-Needle Lateral Sacroplasty Technique
American Journal of Neuroradiology Nov 2018, DOI: 10.3174/ajnr.A5884

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Single-Needle Lateral Sacroplasty Technique
P.J. Nicholson, C.A. Hilditch, W. Brinjikji, A.C.O. Tsang, R. Smith
American Journal of Neuroradiology Nov 2018, DOI: 10.3174/ajnr.A5884
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