From the Guidelines
Hypoplasty, specifically kyphoplasty, should be considered for acute thoracic compression fractures in the following order of indications, prioritizing those with the highest risk of morbidity and mortality. The indications for hypoplasty in acute thoracic compression fractures include:
- Patients with severe, debilitating pain unresponsive to conservative management for 3-6 weeks, particularly those scoring 7 or higher on a 10-point pain scale, as this can significantly impact their quality of life 1.
- Patients with progressive vertebral body collapse exceeding 20% of vertebral height or with kyphotic deformity greater than 20 degrees, which can lead to further complications and decreased functional status.
- Elderly patients (typically over 65) with osteoporotic fractures who are at high risk for complications from prolonged immobility or analgesic medications, as they are more susceptible to morbidity and mortality 1.
- Patients with pathological fractures due to underlying malignancy causing significant pain, as kyphoplasty has been shown to be effective in providing immediate pain relief and improving functional status in these patients 1.
- Patients with multiple compression fractures affecting functional status and quality of life, as hypoplasty can help stabilize the fractures and prevent further collapse.
It is essential to note that contraindications for hypoplasty include active infection, uncorrected coagulopathy, spinal cord compression, and fractures with posterior wall disruption causing canal compromise. The procedure involves percutaneous injection of bone cement into the fractured vertebra, with kyphoplasty specifically using balloon inflation to create a cavity before cement injection, providing immediate pain relief and stabilizing the fracture 1.
From the Research
Indications for Hypoplasty in Acute Thoracic Compression Fracture
- The decision to perform hypoplasty, such as vertebroplasty or kyphoplasty, in acute thoracic compression fracture depends on various factors, including the severity of the fracture, presence of neurological deficits, and the patient's overall health status 2, 3, 4.
- According to a study published in the Journal of Neurointerventional Surgery, vertebroplasty is a safe and effective treatment for post-traumatic thoracic-lumbar fractures compared to conservative management 2.
- A review of current concepts in the management of vertebral compression fractures suggests that vertebral augmentation procedures, including vertebroplasty and kyphoplasty, can provide significant pain reduction and improvement in functional ability compared to non-surgical management 3.
- The management of thoracolumbar spine fractures involves a careful evaluation of the fracture type, degree of bony compromise, neurological involvement, and the integrity of the posterior ligamentous complex 4.
- A network meta-analysis of randomized controlled trials found that the risk of adjacent-level fractures after vertebroplasty and kyphoplasty is similar to that observed in the natural history after osteoporotic vertebral compression fractures 5.
Key Considerations
- The presence of neurological deficits or instability of the fracture may require surgical intervention, such as hypoplasty, to stabilize the spine and prevent further injury 2, 4.
- The patient's overall health status, including the presence of osteoporosis or other comorbidities, should be taken into account when deciding on the best course of treatment 3, 5.
- A thorough discussion of the risks and benefits of hypoplasty, as well as alternative treatment options, should be had with the patient to ensure informed decision-making 2, 3, 4.