Transpedicular and Posterolateral Approach in the Prone Position

The transpedicular and posterolateral approaches can be achieved in the prone position on a C-arm unit. The transpedicular approach is done with the same landmarks as described above at the lumbar level, using a direct approach BTN (Fig. 15). It is well suited for lesions involving the upper part of the thoracic vertebral bodies. In the case of a lesion of the lower part of the vertebral body or the disc space, a posterolateral approach can be achieved with similar landmarks as in the transpedicular route. The needle should cross the intervertebral foramen, imagining an additional pedicle between the vertical lines passing through the medial and lateral cortices of the pedicles of the superior and inferior vertebras used as guiding landmarks (Fig. 6). The needle tip should contact bone on a vertical line passing through the lateral cortex of the pedicles and penetrate the vertebral body on the lateral view before crossing the vertical line passing through the medial cortex of the pedicles on the anterioposterior view (Fig. 15). The

FIGURE 14 Disc biopsy of a spinal tuberculosis at T6-T7. A 35° oblique view (A) demonstrates the same anatomic relations as those in Figure 13. (B) Anteroposterior view.

FIGURE 15 Transpedicular approach at the thoracic level. (A) Point of bone contact, (B) needle projections when entering the vertebral body, and (C) final placement. Source: Reproduced with the kind permission of Kyphon Inc.

disc space may also be approached with the patient in the prone position with the technique of the "imaginary pedicle" (Fig. 16).

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