La radiologie interventionnelle en pathologie rachidienne

Abstract

The vertebroplasty is based on intracorporeal acrylic resin injection. Its 2 main objectives are analgesia and bone consolidation. Its main indications are painful and inflammatory fractures on a site of osteopathic fragility and bone metastases. Its clinical efficacy is strongly correlated with a treatment performed within 3 months post fracture. Transpedicular acrylic resin injection is performed under scopic control in order to continuously follow the intra-corporeal filling of the cement and thus limit the risk of complications. Main risks of vertebroplasty are rare and represented by the risk of extracorporeal leak, disc, foraminal, in the epidural space, the periventricular and epidural veins or the inferior vena cava or the lung about acrylic resin injection. For the spinal tumoral pathology, each file is the subject of a multidisciplinary discussion where essential elements to the global care of the patients are necessary to collect and to take into account, in particular the general state of the patient and its life expectancy and the goal of treatment (curative or palliative). The main techniques of hot ablathermy are represented by laser, radio frequency or microwaves and cold ablathermy by cryoablation. Different guidance techniques (fluoroscopy, CT, MRI, etc.) are available to interventional radiologists to perform their actions in conditions of maximum safety and efficiency. It is necessary to put in place a passive protection (thermocouple or electrostimulation) or active protection (displacement of the organs, insufflation of CO2, hydro-dissection, cooling or warming) of the neighboring organs, in particular of the nerves.