Explain how to safely access the thoracic and lumbar spine with a Jamshidi needle to perform a vertebroplasty or kyphoplasty

The most common approach utilized is the transpedicular approach. Anteroposterior (AP) and lateral fluoroscopy is mandatory, and use of two C-arms is ideal, to permit simultaneous AP and lateral views of the target vertebra. The level of the fracture is localized on the AP view. The skin is marked at the lateral border of the pedicle on the AP view. A small incision is made and the needle is advanced to contact bone at the 10 o'clock position on the left pedicle and 2 o'clock position on the right pedicle on the AP view. Next, the lateral view is examined to guide needle trajectory in the sagittal plane. The needle is advanced into the vertebral body while monitoring its path on AP and lateral fluoroscopic images. To avoid violation of the medial pedicle wall and unintended entry into the spinal canal, the needle should not cross the medial pedicle border on the AP fluoroscopic view until the needle has passed the posterior cortex of the vertebral body on the lateral view.

In the thoracic spine, a modification of the standard approach, the lateral extrapedicular approach, may be used when the pedicles are small and difficult to cannulate. In the lumbar spine, a posterolateral extrapedicular approach is also an alternative to the standard transpedicular approach.

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