What is kyphoplasty (vertebral augmentation procedure)?

From the Guidelines

Kyphoplasty is strongly recommended for the management of painful vertebral compression fractures in cancer patients, as it provides immediate pain relief, improves functional status, and allows for outpatient care. The Cancer Patient Fracture Evaluation study, a randomized controlled trial, demonstrated significant improvements in back-specific functional status measured by the Roland-Morris disability questionnaire (RDQ) score at 1 month, with a mean change of 8.3 points in the kyphoplasty group compared to 0.1 points in the control group 1. The advantages of kyphoplasty include:

• Immediate pain relief
• Avoiding delays in chemoradiation
• Outpatient care in the majority of cases
• Biopsy of tissue
• Vertebral height restoration
• Potential antitumor effect of bone cement The procedure has been shown to be effective in treating symptomatic vertebral compression fractures, with significant improvements in functional status and pain relief, making it a valuable treatment option for cancer patients with vertebral fractures 1.

From the Research

Kyphoplasty Overview

• Kyphoplasty is a minimally invasive percutaneous technique used for the treatment of osteoporotic vertebral compression fractures in the thoracic and lumbar spine 2.
• The procedure involves the transpedicular inflation of balloon tamps, creating a cavity that is then filled with polymethylmetacrylate (PMMA) under low pressure 2.
• Kyphoplasty can help restore vertebral height and reduce the potential for extravertebral cement leakage 2.

Comparison with Vertebroplasty

• Both kyphoplasty and vertebroplasty are used to treat osteoporotic vertebral compression fractures, but they differ in their approach and outcomes 3, 4.
• Vertebroplasty involves the injection of cement via one or both pedicles under high pressure, while kyphoplasty uses a balloon tamp to create a cavity for cement injection 2.
• Studies have shown that both procedures can reduce pain and improve function, but kyphoplasty may have a lower risk of cement leakage and a trend toward longer fracture-free survival 3, 4.

Technical Considerations and Complications

• Kyphoplasty can be performed with a transpedicular or extrapedicular access, and PMMA-cement is the preferred material due to its biomechanical properties and effectiveness in pain reduction 5.
• Common complications of kyphoplasty include cement leakage and adjacent segment fractures, while rare complications include toxic PMMA-monomer reactions, cement embolization, and infection 5.
• The distribution of PMMA within the vertebral body can affect the risk of recompression, with a "contacted" distribution pattern (where the PMMA contacts both upper and lower endplates) associated with a lower risk of recompression 6.

Outcomes and Efficacy

• Studies have demonstrated that kyphoplasty can provide significant pain reduction and improvement in function, with some studies showing a trend toward longer fracture-free survival compared to vertebroplasty 3, 4.
• A randomized trial comparing kyphoplasty and vertebroplasty found similar long-term improvements in pain and disability, but with fewer cement leakages and a trend toward longer fracture-free survival with kyphoplasty 4.
• The efficacy of kyphoplasty in reducing pain and improving function has been consistently demonstrated across multiple studies, making it a viable treatment option for osteoporotic vertebral compression fractures 3, 5, 4.