OBJECTIVE. This study aimed to evaluate the reproducibility of a new grading system for lumbar foraminal stenosis.MATERIALS AND METHODS. Four grades were developed for lumbar foraminal stenosis on the basis of sagittal MRI. Grade 0 refers to the absence of foraminal stenosis; grade 1 refers to mild foraminal stenosis showing perineural fat obliteration in the two opposing directions, vertical or transverse; grade 2 refers to moderate foraminal stenosis showing perineural fat obliteration in the four directions without morphologic change, both vertical and transverse directions; and grade 3 refers to severe foraminal stenosis showing nerve root collapse or morphologic change. A total of 576 foramina in 96 patients were analyzed (from L3–L4 to L5–S1). Two experienced radiologists independently assessed the sagittal MR images. Interobserver agreement between the two radiologists and intraobserver agreement by one reader were analyzed using kappa statistics.RESULTS. According to reader 1, grade 1 foraminal st...

We analysed the CT scans and radiographs of 76 vertebrae in 49 patients who underwent vertebroplasty for painful osteoporotic compression fractures. Leaks of cement were classified into three types: those via the basivertebral vein (type B), via the segmental vein (type S), and through a cortical defect (type C). More leaks were identified on CT scans than on radiographs by a factor of 1.5 (74/49). Most type-B (93%) and type-S (86%) leaks were missed or underestimated on a lateral radiograph which is usually the only view used during the injection of cement. Of the leaks into the spinal canal, only 7% (2/28) were correctly identified on radiographs. The areas on lateral radiographs where this type of leak may be observed were divided into four zones, and their diagnostic value in predicting a leak into the spinal canal was evaluated. The results showed that cement in the neural foramina had the highest positive predictive value (86%).

To prospectively evaluate the incidence of, characteristics of, and risk factors for pulmonary cement embolism after percutaneous vertebroplasty (PVP) in osteoporotic vertebral compression fractures (VCFs). Institutional review board approval and written informed consent were obtained. From June 2006 to September 2007, 75 patients (57 women, 18 men; mean age, 74.78 years; range, 48-93 years) who underwent 78 PVP sessions at 119 levels for osteoporotic VCFs were prospectively enrolled in this study. Computed tomographic (CT) scans of the chest and treated vertebrae were obtained after PVP. The presence, location, involved pulmonary arteries, number, and size of each pulmonary cement embolus were analyzed at CT. Possible risk factors were analyzed as follows: Age, injected cement volumes, and numbers of treated vertebrae were analyzed by using the Mann-Whitney U test; operators (radiologist or nonradiologist), level of treated vertebrae, guidance equipment, approach (uni- or bipedicular), presence of intravertebral vacuum clefts, and presence of paravertebral venous leakage were analyzed by using Pearson chi(2) and Fisher exact tests. Pulmonary cement emboli developed in 18 (23%) of 78 PVP sessions and were detected in the distal to third-order pulmonary arteries. Only cement leakage into the inferior vena cava showed a statistically significant relationship to pulmonary cement embolism (P = .03). A higher frequency of pulmonary cement embolism was noted for the absence of intravertebral vacuum clefts, for the bipedicular approach, and for a nonradiologist operator with C-arm fluoroscopy (P > .05). In osteoporotic VCFs, pulmonary cement embolism was detected in 23% of PVP sessions, developed in the distal to third-order pulmonary arteries, and was related to leakage into the inferior vena cava.

Yang JJ, et al. Clin Orthop Surg. 2011 Mar;3(1):16-23. http://dx.doi.org/10.4055/cios.2011.3.1.16