Can a patient with a severe burst vertebral fracture receive a vertebroplasty (vertebral augmentation procedure)?

From the Guidelines

Vertebroplasty may be considered as part of a comprehensive treatment plan for patients with severe burst vertebral fractures, but it is not recommended as a primary treatment due to the risk of cement leakage and spinal instability, and should be evaluated by a spine specialist on a case-by-case basis. The management of severe burst vertebral fractures typically requires a multidisciplinary approach, including interventional radiology, surgery, and radiation oncology consultation, as recommended by the American College of Radiology 1. Percutaneous vertebral augmentation (VA) procedures, such as vertebroplasty, have been shown to be effective in treating symptomatic vertebral compression fractures, with advantages including immediate pain relief and vertebral height restoration 1. However, the timing and appropriateness of VA procedures have been debated, and the decision to perform vertebroplasty should be based on factors including the specific fracture pattern, neurological status, overall patient health, and potential risks 1. In general, vertebroplasty is not recommended as a primary treatment for severe burst vertebral fractures, and patients should be evaluated by a spine specialist to determine the most appropriate treatment strategy, which may include a combination of surgical intervention, bracing, and rehabilitation. Some studies suggest that vertebroplasty/kyphoplasty may be considered for refractory pain associated with vertebral compression fractures in selected patients, but this should be done with caution and careful consideration of the potential risks and benefits 1. The use of vertebroplasty in burst fractures is a complex issue, and the decision to perform the procedure should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances. Key considerations include the risk of cement leakage, the potential for spinal instability, and the need for comprehensive management, including surgical stabilization and rehabilitation. Ultimately, the goal of treatment should be to improve the patient's quality of life, reduce morbidity and mortality, and minimize the risk of complications. In making this decision, it is essential to weigh the potential benefits of vertebroplasty against the potential risks and to consider alternative treatment options, such as surgical stabilization and bracing. By taking a comprehensive and multidisciplinary approach to the management of severe burst vertebral fractures, healthcare providers can help to ensure the best possible outcomes for their patients.

From the Research

Vertebroplasty for Severe Burst Vertebral Fractures

• Vertebroplasty, a minimally invasive surgical procedure, has been used to treat osteoporotic compression fractures, vertebral myeloma, and metastases 2.
• The procedure involves injecting polymethylmethacrylate into the compressed vertebral body to provide immediate stability and pain relief.
• Some studies have investigated the use of vertebroplasty for the treatment of spinal burst fractures, which are typically considered a contraindication for this procedure 2, 3.

Clinical Outcomes and Safety

• A study published in 2009 found that vertebroplasty can be a safe and effective treatment for osteoporotic burst fractures without neurological deficit, with significant improvements in kyphosis angle, wedge angle, and height restoration 2.
• Another study published in 2012 reported a case of a patient with a lumbar burst fracture who was treated with vertebroplasty and achieved good fracture healing and symptom relief without major surgical complications 4.
• However, the use of vertebroplasty for burst fractures is not without risks, and careful patient selection and caution are necessary to prevent complications such as cement leakage into the spinal canal 3.

Treatment Options and Philosophies

• A review article published in 2014 discussed the various treatment options for vertebral fractures, including vertebroplasty, kyphoplasty, and other minimally invasive surgical procedures 5.
• The article highlighted the importance of early surgical intervention, optimal technical equipment, and an experienced interdisciplinary team in achieving successful outcomes with vertebral augmentation techniques.
• The selection of material for vertebral augmentation, such as polymethylmethacrylate (PMMA), and the choice of surgical method, such as radiofrequency kyphoplasty, can depend on various factors, including the individual patient's situation and the surgical team's experience 5.