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Surgically controlled, transpedicular methyl methacrylate vertebroplasty with fluoroscopic guidance. Acta Neurochir 1999; 141:625–631. 25. Barr JD, Barr MS, Lemley TJ, McCann RM. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 2000; 25:923–928. 26. Heini PF, Walchli B, Berlemann U. Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J 2000; 9:445–450.

Spine 1999; 24:1521–1526. 75. Cunin G, Boissonnet H, Petite H, Blanchat C, Guillemin G. Experimental vertebroplasty using osteoconductive granular material. Spine 2000; 25:1070–1076. 76. Verlaan JJ, van Helden WH, Oner FC, Verbout AJ, Dhert WJ. Balloon vertebroplasty with calcium phosphate cement augmentation for direct restoration of traumatic thoracolumbar vertebral fractures. Spine 2002; 27:543–548. © 2004 by Marcel Dekker, Inc. A. A. I. INTRODUCTION Spine care is trending towards procedures that are less invasive and motion sparing.

In this view, the needle should be entirely contained within the pedicle. If proper orientation cannot be confirmed, the needle should be repositioned. In order to maximize the amount of cancellous bone between the bone tamp and the fractured endplate, the instruments can be directed towards the uninjured endplate. For example, if the superior endplate is depressed, the tools are directed towards the anterior lip of the inferior endplate. Importantly, the instruments should not be advanced through the intact endplate, as this can lead to cement extravasation into the disc space.

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