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Initial positioning for needle trajectory for transpedicular (A and B) and parapedicular (C and D) approaches. (A) Anteroposterior (AP) fluoroscopic image.
The image intensifier is first rotated to a true AP position, aligning the spinous process midway between the pedicles (vertical dotted line). The
craniocaudad angulation is changed to bring the pedicles to the midportion of the vertebral body (horizontal dotted lines). The needle tip lies at 3 o'clock of
the target right pedicle. (B) Lateral fluoroscopic image. The image intensifier is rotated to a true lateral position by overlapping the cortices of both pedicles
and ensuring that the posterior margin of the vertebral body is aligned (dotted lines). The needle tip lies at the junction of the pedicle and the posterior
vertebral arch. (C) AP fluoroscopic image. A true AP position with appropriate craniocaudad angulation achieved. The needle tip lies at 9 o'clock of the
Source: Vertebral Augmentation, Principles and Practice of Pain Medicine, 3e
target left pedicle. (D) Lateral fluoroscopic image. With the parapedicular approach, the needle tip enters bone more anteriorly, at the junction of the
Citation: body.
Bajwa ZH, Wootton R, Warfield CA. Principles and Practice of Pain Medicine, 3e; 2016 Available at: http://mhmedical.com/ Accessed:
pedicle and vertebral
May 12, 2017
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