What are vertebroplasty and kyphoplasty?

Vertebroplasty and Kyphoplasty: Minimally Invasive Vertebral Augmentation Procedures

Vertebroplasty and kyphoplasty are minimally invasive surgical procedures designed to treat painful vertebral compression fractures by stabilizing the fractured vertebral body through the injection of bone cement, with kyphoplasty offering the additional benefit of potential height restoration through balloon inflation prior to cement injection. 1

Definition and Procedural Differences

Vertebroplasty

• A procedure involving the percutaneous injection of bone cement (typically polymethyl methacrylate or PMMA) directly into a fractured vertebral body
• Performed under local anesthesia in most cases
• Primary goal: Stabilization of the fractured vertebra to relieve pain 2

Kyphoplasty

• Also known as "balloon-assisted vertebroplasty"
• Involves the initial inflation of a percutaneously delivered balloon in the vertebral body, creating a cavity
• The cavity is then filled with bone cement after balloon removal
• Performed under local anesthesia in most cases
• Primary goals:
  • Stabilization of the fractured vertebra
  • Potential restoration of vertebral body height
  • Reduction of kyphotic deformity 2, 1

Indications

Both procedures are indicated for:

1. Osteoporotic vertebral compression fractures refractory to conservative medical therapy 2, 1
2. Cancer-related vertebral compression fractures, particularly in patients with disabling pain 2, 1
3. Painful hemangiomas of the vertebral body 3

Patient Selection Criteria

Ideal candidates include patients with:

• Confirmed thoracic/lumbar vertebral fracture by advanced imaging (CT or MRI)
• Pain causing loss of mobility or inability to perform baseline daily activities
• Failure of conservative management
• No osteomyelitis at the surgical site 1

Efficacy and Outcomes

Pain Relief

• Both procedures demonstrate significant immediate and sustained pain relief in 84-95% of patients 2, 4
• Mean Visual Analogue Scale (VAS) scores typically decrease from approximately 8.3 preoperatively to 2.7 postoperatively 5

Structural Benefits

• Kyphoplasty can improve vertebral height by 32-43% and reduce kyphotic angle from an average of 15.4° to 11.2° when performed within 3 months of fracture 5, 4
• Height restoration is more effective when the procedure is performed within 3 months of fracture onset 4

Functional Outcomes

• Improved mobility and quality of life
• Reduced need for pain medications
• Earlier hospital discharge and return to activities 1, 5

Comparative Considerations

• Kyphoplasty may offer better height restoration and kyphosis correction compared to vertebroplasty 4
• Vertebroplasty has a higher rate of cement leakage compared to kyphoplasty 6
• Kyphoplasty is approximately 2.5 times more expensive than vertebroplasty 2
• Both procedures show similar pain relief outcomes 2

Procedure Details

The procedures are typically performed as follows:

• Patient positioned prone
• Local anesthesia administered
• Percutaneous approach (usually transpedicular)
• For kyphoplasty: balloon inflation creates a cavity before cement injection
• For vertebroplasty: direct cement injection
• Mean operation time: approximately 20 minutes per vertebra
• Most patients can be discharged the same day or next day 1, 5

Potential Complications

• Cement leakage (more common with vertebroplasty)
• Spinal cord or nerve root compression
• Venous embolism
• Pulmonary embolism
• Adjacent vertebral fractures
• Infection 1, 3

Post-Procedure Care

• Pain assessment using standardized scales
• Functional status evaluation
• Radiographic follow-up to assess cement distribution
• Patients should report any sudden increase in back pain as it may indicate a new fracture
• Comprehensive osteoporosis management is crucial to prevent future fractures 2, 1

Clinical Practice Recommendations

According to the Society of NeuroInterventional Surgery guidelines:

1. Kyphoplasty is superior to conservative medical therapy for cancer patients with disabling back pain from vertebral fractures (Class IIA, Level B)
2. Both vertebroplasty and kyphoplasty are reasonable options for selected patients with severe back pain from osteoporotic or cancer-related vertebral fractures that are refractory to conservative medical therapy (Class IIA, Level B) 2

Both procedures should be considered as part of a comprehensive treatment approach that includes appropriate medical management of underlying conditions such as osteoporosis or malignancy.