Indications and results of kypho- and vertebroplasty

Abstract

The best currently available evidence based treatment reduces vertebral fracture risk but does not totally prevent osteoporotic and malignant follow-up fractures. Kyphoplasty and vertebroplasty are options of a causal treatment to reduce pain by internal stabilization of fractured vertebrae. The indication for these minimal invasive procedures requires an interdisciplinary discussion of the individual case to guarantee technical feasibility, to increase the likelihood that these procedures will indeed reduce pain and to embed these procedures into the long term therapeutic concept of every single patient. In addition to internal stabilization of a painfully fractured vertebra kyphoplasty also seeks to restore lost vertebral height which appears promising in acute vertebral fractures. Due to the procedure there are more cement leakages after vertebroplasty. Available controlled prospective studies demonstrate only for kyphoplasty a long-term benefit for the patient in terms of pain reduction, increased mobility and improved quality of life.

Percutaneous Balloon Kyphoplasty with the Patient under Intravenous Analgesia and Sedation: A Feasibility Study

“…While this heterogeneity may impair comparability between the groups, it may, on the other hand, reflect the patient population likely to be candidates for BKP in the clinical setting and is shared by other recent studies. 3,8,21,34 Conclusions BKP with conscious sedation by using piritramide and midazolam is a safe and feasible method for minimally invasive treatment of metastatic and osteoporotic vertebral fractures in patients with increased anesthesia risk.…”

“…3,5,6 BKP, which is technically more demanding and complex, is typically performed with the patient under general anesthesia. [6][7][8] However, patients undergoing this treatment are generally older and have numerous illnesses simultaneously, 4,9 increasing the risk of anesthesia-related complications. There are a number of studies describing the anesthesia procedures used for VP, 10,11 but to the best of our knowledge, there is no report about BKP with the patient under conscious sedation in the literature so far.…”

Evaluation of the in vitro cell-material interactions and in vivo osteo-integration of a spinal acrylic bone cement

“…In the light of cancellous bone augmentation procedures, the handling and mechanical properties of PMMA bone cements are superior to other materials such as calcium phosphate cements (CPC) [38,39]. However, polymeric compounds cannot compete with pure ceramics on bioactivity [10,11,17,40], but using CPCs other drawbacks such as cement failure [38] or particle/ion release could lead to tremendous clinical risks like embolism [41].…”