Percutaneous Vertebroplasty and Kyphoplasty

Excerpt

Osteoporotic compression fractures are the most common fragility fractures today. Individuals with osteoporosis may experience a vertebral compression fracture from seemingly insignificant trauma, such as sitting down abruptly. A higher-energy axial loading force is required to compress the vertebral body in younger individuals. Non-osteoporotic lumbar compression fractures are typically observed in motor vehicle accidents or falls from heights. Infectious and malignant processes that weaken vertebrae can also lead to an eventual compression fracture.

These fractures can lead to significant physical limitations, including back pain and functional disability. Compression fractures are prone to progression over time and may facilitate the compression of adjacent vertebrae due to compensatory increases in axial load. Due to the high prevalence of this injury, there is a considerable socioeconomic burden associated with the disease, and there is significant controversy regarding optimal treatment.

Vertebroplasty and kyphoplasty are percutaneous interventional procedures used to treat symptomatic, nonhealing fragility fractures of the spine by injecting polymethyl methacrylate into the vertebral body, providing structural support (see Image. Fluoroscopic Image of Cement Injection During Percutaneous Kyphoplasty). These procedures have faced scrutiny due to the lack of significant clinical improvement noted in 2 early randomized controlled trials, which had significant methodological limitations. Some of these limitations included the inclusion of patients with chronic fractures and those with less severe pain or disability, as well as the performance of an alternative intervention rather than a sham procedure. Although the effectiveness of vertebroplasty and kyphoplasty has been debated, substantial evidence currently demonstrates its advantages over nonoperative treatment. Vertebroplasty is associated with a higher incidence of polymethyl methacrylate extravasation than kyphoplasty; consequently, kyphoplasty has become the preferred surgical intervention for osteoporotic compression fractures.