Every year, there are approximately 750,000 spine vertebrae fractures in the US. The risk of a spine compression fracture during the life of white women is close to 16%. Most vertebral compression fractures are due to osteoporosis. Less common reasons include multiple myeloma, a metastatic tumor or a hemangioma.
The vertebroplasty procedure was first performed in the late 1980s for treating hemangiomas of the spine that were painful. This provided significant pain relief and was then started to be performed in Europe for multiple myeloma and metastatic tumors in the spine. In the 1990s, the procedure was begun in the US for treating osteoporotic compression fractures.
In the early 2000s, kyphoplasty became FDA approved for treatment compression fractures. These procedures are both performed by interventional pain management doctors, spine surgeons, anesthesiologist or radiologist. Both vertebroplasty and kyphoplasty have a good safety profile. There is a very small risk of neurologic compromise if the cement that is injected extravasates from outside the bone and potentially damages the nerve root for the spinal cord.
Both vertebroplasty and kyphoplasty procedures begin the same way. They both use image guidance, specifically fluoroscopy to ensure accurate placement of the surgical instruments. Patients are placed in the prone position, which means their belly is down and well padded on the table that x-ray can go through.
These procedures involve inserting a metallic catheter through the bone on either side of the spinal canal known as the pedicles.
Most of the time, the metallic catheter is placed from both sides, meaning on the left and right. Once the metallic catheters are in position where the fracture is, this is where the two procedures differ. For the vertebroplasty procedure, the bone cement is injected at that point. The cement includes some contrast so that the doctor can see where exactly is going.
The objective is for the cement to fill in the fracture lines and become essentially an internal brace. Once the decision is made that enough cement has been
placed, the procedure is considered complete. Usually it takes about 20 minutes for the cement to completely harden and it becomes very warm in the process.
In contrast to a vertebroplasty, a kyphoplasty involves balloon inflation prior to the insertion of cement. Balloons filled with saline are inflated in the vertebral body and push the fracture fragments out-of-the-way to create a bony void.
The balloons are then deflated and removed, and then the bone cement is inserted under low pressure to fill in the void. The cement that goes in hardens within about 20 minutes and the theory with a kyphoplasty is that some of the lost height from the fracture can be restored. In addition, since the cement is being inserted under lower pressure than a vertebroplasty, then less potential exists for cement extravasation.
There are quite a few studies showing the beneficial effects of vertebroplasty and kyphoplasty for spinal compression fractures. There have been some studies refuting the beneficial effects, but there were shown to be some issues with how those studies were performed. Therefore, it is widely believed in the medical community that these procedures are very helpful for those with compression fractures to increase functional mobility and decrease pain rapidly.
Interventional pain management doctors often perform these procedures for those dealing with significant pain from spinal compression fractures. With a compression fracture, often times a brace is tried first. Then if that fails, a vertebroplasty or kypoplasty is often the best next logical step.
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