Percutaneous cement augmentation for osteoporotic vertebral fractures

Abstract

Thoracolumbar vertebral fracture incidents usually occur secondary to a high velocity trauma in young patients and to minor trauma or spontaneously in older people.Osteoporotic vertebral fractures are the most common osteoporotic fractures and affect one-fifth of the osteoporotic population.Percutaneous fixation by 'vertebroplasty' is a tempting alternative for open surgical management of these fractures.Despite discouraging initial results of early trials for vertebroplasty, cement augmentation proved its superiority for the treatment of symptomatic osteoporotic vertebral fracture when compared with optimal medical treatment.Early intervention is also gaining ground recently.Kyphoplasty has the advantage over vertebroplasty of reducing kyphosis and cement leak.Stentoplasty, a new variant of cement augmentation, is also showing promising outcomes.In this review, we describe the additional techniques of cement augmentation, stressing the important aspects for success, and recommend a thorough evaluation of thoracolumbar fractures in osteoporotic patients to select eligible patients that will benefit the most from percutaneous augmentation. A detailed treatment algorithm is then proposed. Cite this article: EFORT Open Rev 2017;2:293-299. DOI: 10.1302/2058-5241.2.160057.

Keywords: bone cement; kyphoplasty; osteoporotic vertebral fracture; vertebroplasty.

Fig. 1

A 68-year-old woman with a history of a fall two months previously presented to our clinic for mid-back pain. Radiographs showed a T8 fracture (a). MRI confirmed the diagnosis with little hyperintensity on T2-weighted images (b, c). She was treated with a T8 kyphoplasty (d,e).

Fig. 2

Positioning of the patient with two fluoroscopy machines for anteroposterior and lateral imaging.

Fig. 3

Anteroposterior (AP) and lateral radiographs of a normal lumbar spine showing the desired entry point (blue arrow on the AP) and the desired direction of the Jamshidi needle (red line on the lateral radiograph).

Fig. 4

Anteroposterior fluoroscopy image showing the ‘kissing balloon’ image.

Fig. 5

A 58-year-old woman with a non-specified mitochondrial pathology had a history of L1 vertebral fracture treated with kyphoplasty. She presented with pain in the lumbar region after a fall from her height. CT-scanner showed L2 fracture with a deformity in both sagittal and coronal planes (a, b). She was treated with a Spine Jack stentoplasty device with an unremarkable post-operative course. Post-operative scanning showed correction in both sagittal and coronal planes (c, d).

Fig. 6

Algorithm for treating osteoporotic vertebral fractures (OVF).