Current status and challenges of percutaneous vertebroplasty (PVP)

Abstract

A narrative review regarding percutaneous vertebroplasty (PVP) for osteoporotic vertebral fracture (OVF) is provided herein, addressing the epidemic of OVF in Japan, the latest response to the criticism of PVP for OVFs, the indications and potential risks of PVP for OVFs, and a future perspective for PVP. Each year in Japan, approximately 32,000 patients aged 55 years or older suffer from chronic low back pain for several months to several years due to a compression fracture. PVP is one of the surgical treatments for an OVF, and it is less invasive compared to the traditional open surgery. PVP is suitable for OVF patients who have difficulty walking as assessed by the modified Yokoyama’s activities of daily living (ADL) scoring system, and for patients with Kummell's disease diagnosed by CT and MRI examinations. Serious adverse events related to PVP occur in 1.1–3.3% of the cases, but direct deaths from PVP are extremely rare at less than 1%. Recent studies demonstrated that OVF patients treated with PVP are less likely to die after the treatment than non-surgically treated patients, which conflicts with the Cochran reviews’ conclusion not supporting PVP for OVFs. Novel robotic systems and procedure-support devices are being developed, providing a next step toward fully automated PVP procedures.

Efficacy and Complication Rates of Percutaneous Vertebroplasty and Kyphoplasty in the Treatment of Vertebral Compression Fractures: A Retrospective Analysis of 280 Patients

“…These cases were always on the borderline, where the patient was not suitable for a larger procedure, due to e.g., severe comorbidities. On the other hand, leaving some of those fracture untreated would most probably lead to severe deformity and persistent pain [ 5 ].…”

Therapeutic Efficacy and Safety of Percutaneous Curved Vertebroplasty in Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta‐Analysis

“…Although a recent comparative analysis of kyphoplasty and vertebroplasty found significant differences in anatomical recovery with the former technique slightly superior in long‐term kyphotic correction and vertebral height restoration, 47 there is no valid quality evidence of balloon kyphoplasty versus vertebroplasty 20 . Moreover, cementoplasty practically improves quality of life and leads to higher levels of satisfaction, which may benefit from pain relief, a good relationship with the surgeon, and the patient's subjective perceptions 10 . Thus, a modified evaluation system for multicenter RCTs is warranted to assess the impact on quality of life and radiographic results.…”

“…As such, early mobilization and multisegmental treatment simultaneously are permitted, which is particularly applicable to fragile patients. 10 Previous studies also confirmed the clinical superiority of PVP/KP compared to conservative treatments, 11,12 while it must be acknowledged that PVP/KP have limitations. According to an evidenced-based review, 13 the symptomatic complication rates of PVP/KP of osteoporotic at 2.2%-3.9%.…”

“…Vertebral cementoplasty provides rapid pain relief and stabilization with maximum restoration of vertebral height to correct deformities. As such, early mobilization and multisegmental treatment simultaneously are permitted, which is particularly applicable to fragile patients 10 . Previous studies also confirmed the clinical superiority of PVP/KP compared to conservative treatments, 11,12 while it must be acknowledged that PVP/KP have limitations.…”

“Double Cross Sign” Could Be an Indicator of an Adequate Amount of Bone Cement in Kyphoplasty with the SpineJack System: A Retrospective Study

“…In patients with vertebral compression fractures, nonoperative treatment is often difficult to tolerate. Both vertebroplasty and kyphoplasty are well-accepted minimally invasive procedures for the management of painful osteoporotic compression fractures [ 7 , 8 , 9 ]. Although adverse events are rare with both techniques, higher rates of procedure-related complications such as cement leakage were noted in vertebroplasty [ 10 ], and a higher incidence of an adjacent fracture was found after balloon kyphoplasty [ 11 ].…”