A. Orlando Ortiz

Vertebroplasty versus Kyphoplasty: A Comparison and Contrast

The phrase “vertebroplasty versus kyphoplasty” evokes images of competitive procedures and groups of entrenched physicians locked in battle. Our involvement in the development and introduction of percutaneous vertebroplasty (PV) and kyphoplasty (KP) in the United States has given us a unique

Radiation Safety during Spine Interventions

Image-guided spine interventions are being performed by radiologists and other physicians with increased frequency. This article assesses the use of several techniques and devices that can mitigate radiation exposure during interventional procedures. Measurements were obtained on a humanoid phantom with use of various shielding methods. Significant radiation dose reductions as great as 98.7% can be achieved with use of a combination of stationary and mobile lead barriers and operator position. The application of basic radiation physics in combination with prudent radiographic technique can significantly reduce radiation exposure to the operator and other personnel during spine interventions.

Noncardiac Implantable Pacemakers and Stimulators: Current Role and Radiographic Appearance

OBJECTIVE The purpose of this pictorial essay is to familiarize radiologists with the clinical functioning, proper anatomic positioning, appearance on radiographs and CT scans, potential complications, and MRI safety issues of several implantable noncardiac pacemaker and stimulator devices. CONCLUSIONS The use of noncardiac pacemakers and stimulators is rapidly increasing because of the utility of these devices in the management of surgically and medically refractory conditions. Unlike cardiac pacemakers, electrical stimulators are MRI compatible under certain circumstances.

Migratory Transient Osteoporosis of the Hip Occurring Before and During Pregnancy

The authors present a case of migratory transient osteoporosis of the hip in a patient who was 25 weeks pregnant and who had a similar episode in the opposite hip 9 months earlier. Although now most frequently identified in middle-aged or older men, transient osteoporosis of the hip was initially de

Imaging evaluation of cranial nerves 3, 4, and 6.

Neuropathies of the oculomotor, trochlear, and abducens nerves may present with isolated or complex neurologic findings. An understanding of the anatomy of these cranial nerves as they traverse the brainstem, basilar cisterns, and cavernous sinus on their way to the orbit can assist in localizing the suggested site of pathology and help to focus imaging protocols. Differential diagnostic possibilities for specific anatomic locations are reviewed.

Improved outcomes with direct percutaneous CT guided lumbar synovial cyst treatment: advanced approaches and techniques

Purpose To determine if lumbar synovial cyst rupture in symptomatic patients results in improved clinical outcome when using direct tandem and/or coaxial percutaneous CT guided techniques. Materials and methods 20 patients with unilateral lower extremity radiculopathy and/or low back pain underwent CT guided percutaneous treatment for their symptomatic lumbar synovial cysts. Cysts were identified with the use of a low osmolar non-ionic contrast agent via facet joint injection or through direct injection. Cyst rupture, using a direct tandem and/or coaxial technique, was attempted in all patients using an 18 gauge guide needle and a 22 gauge insert needle. Following attempted cyst aspiration, cyst rupture was performed using 1–3 mL of a mixture of methylprednisolone (2 mL, 80 mg) and bupivacaine (3 mL, 0.5%). All patients were followed-up in clinic for a minimum of 6 months after their procedures and up to a maximum of 24 months. Results 11 patients were male and nine were female, with an average age of 65.6 years. 17 patients presented with severe unilateral lower extremity radiculopathy and three patients were experiencing low back pain. One of the patients had two synovial cysts, and therefore a total of 21 lumbar synovial cysts were treated in this group of patients. Direct cyst puncture was achieved using a tandem technique in nine patients, a coaxial interlaminar approach in seven patients, a coaxial transforaminal approach in two patients, and a coaxial trans-facet approach in three patients. Cyst rupture was documented in all cases, as evidenced by CT confirmation of cyst decompression and contrast agent extravasation into the epidural space. The mean surveillance period in these patients was 18 months. Six patients experienced their usual radicular pain within 2 months of their treatment. Four of these patients were re-treated for recurrent smaller cysts. These patients have not had a recurrence at 24 months of follow up. Two of these six patients elected to undergo open surgical decompression without symptomatic improvement. No treatment related complications were observed in this group of patients. Conclusions Direct tandem and/or coaxial percutaneous CT guided techniques for rupture and treatment of symptomatic lumbar synovial cysts reduces recurrence rates and therefore helps avoid more invasive open surgical procedures in this group of patients.

Image-Guided Percutaneous Spine Biopsy

Image-guided percutaneous spine biopsy is a procedure that can be performed safely and efficiently by radiologists. The procedure is performed to determine accurately the composition of abnormal tissue. The information obtained from the biopsy procedure can be used to guide patient management. The radiologist is part of a team that includes the patient, the referring clinician, and a pathologist. Optimal communication among the team members will increase the likelihood of a successful procedural outcome.

Lower Gastrointestinal Bleeding from the Internal Iliac Artery: Angiographic Demonstration of an Iliac Arteriocolic Fistula

A rare source of potentially massive lower gastrointestinal hemorrhage in women is advanced gynecologic malignancy. Such patients can develop gastrointestinal hemorrhage with or without prior pelvic irradiation, due to arteriocolic fistulas. Angiography permits the correct diagnosis and subsequent embolotherapy.

Radiologic evaluation and management of postoperative spine paraspinal fluid collections.

Postoperative paraspinal fluid collections can present a management dilemma to both radiologists and surgeons. Although many of these collections present as incidental findings and are unrelated to the presenting signs and symptoms that led to the imaging study, certain collections in the context of the appropriate clinical scenario may require additional evaluation and even emergent intervention. This article reviews those collections that are most frequently encountered and suggests management strategies that may assist in the evaluation and management of the patient.

Postoperative spine imaging in cancer patients.

Primary or metastatic spine tumors can present with pain and/or neurologic compromise depending on their location within the spinal axis. Metastases and multiple myeloma comprise most of these lesions. Management of spinal tumors includes surgical decompression with stabilization (neo), adjuvant chemotherapy and radiation therapy, curettage, bone grafting, bone marrow replacement, and palliative treatment with vertebral augmentation. Pre- and postoperative imaging plays a critical role in the diagnosis and management of patients with spinal tumors. This article reviews postoperative imaging of the spine, including imaging protocols, immediate and long-term routine imaging findings, and emergent findings in symptomatic patients.