1. L4 Vertebral Radiofrequency ablation
  2. L4 Vertebroplasty with cement

INDICATION:   .     




COMPLICATIONS: None immediately


PROCEDURE: Following informed written consent, the patient was placed in the prone position on the interventional radiology table. The patient’s lower back was prepped and draped in the usual sterile fashion. Appropriate AP and lateral fluoroscopic views of the L4 vertebral body were found and presets saved. An appropriate skin site was chosen for a L4 transpedicular approach and anesthetized using 2% lidocaine. Using fluoroscopic guidance, a 22-gauge spinal needle was advanced to the pedicular surface and also anesthetized with 2% lidocaine. A small dermatotomy was made with an 11 blade scalpel. 

Using fluoroscopic guidance, a D-Fine vertebral access needle was placed using a transpedicular approach through the L4 pedicle.  The needle tip was advanced to the posterior third of the vertebral body, with special attention such that the medial aspect of the pedicle was not transgressed.  A curved trocar needle was then advanced through the access cannula in the recommended fashion to obtain cross midline access. The curved trocar needle was replaced with the curved RF antenna. Radiofrequency ablation was performed until the proximal temperature sensor reached over 50 degrees Celsius (taking approximately 45 seconds).

The cement was prepared and cement delivery system was assembled. The RF ablation antenna was replaced with the cement delivery cannula.  The cement was injected under fluoroscopy at the L4 level through the access needle. Cement injection was stopped once there was adequate fill of the vertebral body. The cannula was removed. Hemostasis was achieved with light manual compression. The patient tolerated the procedure well. The patient was then sent from the interventional radiology suite to the post procedural care area for recovery.


FINDINGS: Compression fracture at the L4 vertebral level with approximately 33% loss of central vertebral body height. Post vertebral ablation and augmentation image demonstrates cement appropriately within the L4 vertebral level with slight restoration of height.


IMPRESSION: Successful L4 vertebral ablation and cement augmentation from a L4 unipedicular approach.