Development of a New Support Method for Transpedicular Punctures of the Vertebral Body: The Isocenter Puncture Method

Abstract

Recently, the percutaneous transpedicular puncture of vertebral body under fluoroscopic guidance using a singleplane or biplane C-arm radiographic system has gained acceptance for percutaneous vertebroplasty (PVP) and vertebral bone biopsy [1–4]. PVP is usually performed by bilateral transpedicular puncture to gain uniform distribution of the injected cement in the vertebral body. However, if the tip of the puncture needle is advanced to the midline of the vertebral body, PVP by unilateral transpedicular puncture can be achieved. The unilateral transpedicular approach has advantages over the bilateral transpedicular approach, such as reduction of procedure time, cost, and radiation exposure [5, 6]. However, advancing the needle to the midline under fluoroscopic guidance is technically difficult, as is vertebral bone biopsy of a small lesion in the vertebral body. Currently, the CT-guided approach is used for this purpose [7, 8]. To advance the puncture needle to the target in the vertebral body under fluoroscopic guidance, we developed a new puncture method called the isocenter puncture (ISOP) method using the isocenter of the C-arm radiographic system. The purpose of this paper is to describe the ISOP method and our initial clinical results. The ISOP Concept