[Kyphoplasty-Vertebroplasty. A critical assessment]

Abstract

Clinical issue: Painful vertebral compression fractures.

Standard treatment: Analgesia.

Treatment innovations: Osteoplastic procedures, such as kyphoplasty and vertebroplasty.

Diagnostic workup: Anamnestic and radiological associations of clinical complaints with the radiomorphological findings of vertebral compression fractures are required for an adequate consideration to assess whether an osteoplastic procedure should be carried out. A computed tomography (CT) scan allows a reliable judgement whether an osteoplastic procedure is technically feasible and promising to improve the local vertebral fracture-associated pain.

Performance: Prospective controlled trials have demonstrated a satisfactory improvement of back pain associated with vertebral fractures and parameters of quality of life by osteoplastic interventions.

Achievements: No prospective, truly sham-controlled blind trials are currently available which demonstrate an advantage of osteoplastic interventions compared to standard pain treatment; however, the currently published prospective controlled trials show a satisfactory pain reduction by osteoplastic interventions, such as kyphoplasty and vertebroplasty.

Practical recommendations: Painful vertebral fractures and progressive loss of vertebral height of compression fractures should be evaluated in an interdisciplinary team consisting of radiologists, spinal surgeons and internists to assess whether an osteoplastic procedure is technically feasible and promising to improve local pain and immobility associated with vertebral fractures.

Keywords: Analgesia; Kyphoplasty; Osteoporosis; Vertebral fractures; Vertebroplasty.