Vertebral Augmentation: State of the Art

Abstract

Osteoporotic vertebral compression fractures (OVF) are an increasing public health problem. Cement augmentation (vertebroplasty of kyphoplasty) helps stabilize painful OVF refractory to medical treatment. This stabilization is thought to improve pain and functional outcome. Vertebroplasty consists of injecting cement into a fractured vertebra using a percutaneous transpedicular approach. Balloon kyphoplasty uses an inflatable balloon prior to injecting the cement. Although kyphoplasty is associated with significant improvement of local kyphosis and less cement leakage, this does not result in long-term clinical and functional improvement. Moreover, vertebroplasty is favored by some due to the high cost of kyphoplasty. The injection of cement increases the stiffness of the fracture vertebrae. This can lead, in theory, to adjacent OVF. However, many studies found no increase of subsequent fracture when comparing medical treatment to cement augmentation. Kyphoplasty can have a protective effect due to restoration of sagittal balance.

Kyphoplasty and Vertebroplasty in the Treatment of Osteoporotic Vertebral Fractures

“…8 Vertebroplasty and kyphoplasty have been shown to be effective in improving both pain and the quality of life of patients with OVF, even when compared to conservative treatment. 6,15,16 However, there is still controversy around whether any of these treatments is more effective or safer in terms of the incidence of complications. 6,13,15,16,18 Another controversy revolves around comparing the effectiveness of and complications resulting from the use of one versus two portals.…”

“…1 One of the principal complications is osteoporotic vertebral fractures (OVF), 2,3 with a reported incidence of 117 cases per 100,000 inhabitants, representing 1.4 million patients annually. [4][5][6][7] Unlike other types of osteoporotic fractures, OVFs are usually not associated with trauma. 8 Nonetheless, OVFs are associated with a significant worsening of the morbidity and mortality of patients.…”

“…8 Nonetheless, OVFs are associated with a significant worsening of the morbidity and mortality of patients. 6,9 Over time, the patients with OVF can suffer from chronic pain, reduced quality of life and functionality, low self-esteem, risk of other fragility fractures, 10 medullary compression, and changes in pulmonary function. 11 As regards mortality, an increase of 32% has been reported, adjusted for the age of the patients with OVF.…”

“…8,15 It is for these patients that vertebral augmentation procedures have appeared as an useful alternative in the treatment of OVFs. 6,8,15,16 Among vertebral augmentation procedures, two have shown to be more effective: vertebroplasty and balloon kyphoplasty ( Figure 1). 6,8,16 Vertebroplasty was first described for the treatment of aggressive vertebral hemangiomas of the lumbar spine.…”

“…6,8,15,16 Among vertebral augmentation procedures, two have shown to be more effective: vertebroplasty and balloon kyphoplasty ( Figure 1). 6,8,16 Vertebroplasty was first described for the treatment of aggressive vertebral hemangiomas of the lumbar spine. 17 Bone cement is injected into the vertebra via a transpedicular approach, which helps to stabilize the vertebral fracture, improving both strength and stability.…”