Fig. 3

A 77-year-old female diagnosed with OVCF and a cleft underwent vertebroplasty using both a planned and a second puncture. a The preoperative sagittal CT reconstruction reveals a T₁₁, large, irregular intravertebral cleft with little surrounding the cancellous bone, and the fact that T₁₂ had undergone vertebroplasty 1 year prior. b The trajectory of the initial needle puncture lay along the junction between the cleft and peripheral cancellous bone and thus could be easily adjusted if a second puncture was necessary. c After initial cement injection, the cement was restricted to the cleft. d Redirecting the needle to the region lacking cement. e Final cement injection featuring intra- and extra-cleft dispersion