From the Guidelines
Kyphoplasty is strongly recommended for the management of painful vertebral compression fractures in cancer patients, as it provides immediate pain relief, restores vertebral height, and has a potential antitumor effect of bone cement. The Cancer Patient Fracture Evaluation study, a randomized controlled trial (RCT), demonstrated significant improvement 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 pain relief and improved functional status, making it a valuable treatment option for cancer patients with vertebral fractures 1.
From the Research
Overview of Kyphoplasty
- 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 injection of polymethylmetacrylate (PMMA) into the fractured vertebra to stabilize and reduce the fracture 2, 3.
Comparison with Vertebroplasty
- Kyphoplasty and vertebroplasty are two similar techniques, but kyphoplasty involves the use of a balloon to create a cavity in the vertebra before injecting PMMA, which can help to restore vertebral height and reduce the risk of cement leakage 2, 3.
- Studies have compared the efficacy and safety of kyphoplasty and vertebroplasty, with some showing that kyphoplasty may have a lower risk of cement leakage and a trend towards longer fracture-free survival 4.
Clinical Outcomes
- Kyphoplasty has been shown to reduce pain and improve functional outcomes in patients with osteoporotic vertebral compression fractures 5, 3.
- A study comparing acute and chronic fractures found that kyphoplasty resulted in significant pain relief and improvement in functional outcomes in both groups, with better results in acute fractures 5.
Technical Considerations
- Kyphoplasty can be performed using a transpedicular or extrapedicular approach, and PMMA cement is commonly used due to its favorable biomechanical properties 6.
- Common complications of kyphoplasty include cement leakage and adjacent segment fractures, while rare complications include toxic PMMA-monomer reactions, cement embolization, and infection 6.