Materials Used in Image-Guided Spine Interventions

Abstract

Most image-guided spine interventions are accomplished well with fluoroscopic guidance. It goes without saying that good visualization of the anatomical area being treated is necessary. Most modern fluoroscopic equipment will provide this capability. It is important to view the target anatomy from multiple projections, and therefore a C-arm configuration is used. Fixed-plane fluoroscopic equipment (commonly used for gastrointestinal work) is not sufficient. The most sophisticated equipment in the multidirectional category is the fixed-base, biplane fluoroscopic room (Figure 2.1a). These rooms are common for interventional neuroradiologists but are not routinely available otherwise. The ability to view the target anatomy in two projections at once is a definite luxury and offers the fastest possible needle insertion capability. However, single-plane C-arm systems are fine for all these procedures. The greatest disadvantage is the reduced speed experienced with vertebroplasty and kyphoplasty, but these procedures can also be performed adequately without biplane capability. Fixed-base C-arm (dedicated angiographic) rooms (Figure 2.1b) are more desirable than portable C-arms (Figure 2.1c). This is primarily because of image quality, but also because of the ease of use by the operating physician. Fixed-base angiographic equipment is motorized and can be controlled by the physician. By contrast, in most portable units, projection changes must be made manually by a technologist. This requirement has the disadvantage of requiring the physician to describe the desired projection rather than being able to select it personally, and this generally slows the process. Also, projections that are repeatedly used can be programmed into memory on a fixed-base machine and automatically retrieved with the press of a button. These features make use of the fixed-base rooms simpler and faster