Percutaneous vertebroplasty and kyphoplasty are minimally invasive techniques for the treatment of spinal compression fractures. Vertebroplasty and kyphoplasty are similar, with kyphoplasty involving an additional step of restoring some of the lost height of the compressed vertebral body. The procedure is performed under fluoroscopic or CT guidance. A needle is advanced to the target vertebral level
pedicle and advanced into the vertebral body. Once access is established a special bone cement is injected under image guidance to allow for stabilization of the fracture fragments. During a kyphoplasty, a bone tamp or balloon is utilized prior to bone cement administration, to restore some vertebral body height.
Indications:
Vertebral body compression fracture with ongoing pain secondary to:
- Osteoporosis
- Malignancy
- Hemangioma
Contraindications:
- Asymptomatic compression fracture
- Pain improvement with medical therapy
- Current localized or systemic infection
- Retropulsion of bony fragments resulting in myelopathy
- Spinal canal compromise secondary to tumor
- Uncorrectable coagulopathy
- Allergy to bone cement ingredients
Complications:
- Higher risk of complications noted in patients with spinal metastatic disease (10%)
- Approximately 3% rate of complication in patients with osteoporotic fractures
- Bleeding
- Infection
- Cement embolization
- Posterior element fracture
- Nerve root irritation
- Pneumothorax
Workup:
Spine radiograph. At minimum a radiograph of the vertebra in question should be obtained to document a compression deformity.
Â
CT and MRI. Cross-sectional imaging has the advantage to better define anatomy. MRI is beneficial in determining extent of nerve and spinal cord compromise, which may help delineate pain related to nerve irritation versus fracture.
Prior to the procedure lab work including platelet count and INR should be obtained. A WBC may also be obtain if there is concern for infection.
Results:
Successful pain relief and/or improved mobility achieved in approximately 90% of patients with osteoporotic fractures and 70%-97% of patients with malignancy associated compression fractures.
