Vertebral augmentation with spinal implants: third-generation vertebroplasty

Abstract

This article is to review the different types of vertebral augmentation implants recently becoming available for the treatment of benign and malignant spinal compression fractures. After a detailed description of the augmentation implants, we review the available clinical data. We will conclude with a summary of the advantages and disadvantages of vertebral implants and how they can affect the future treatment options of compression fractures. Keywords Vertebroplasty . Kyphoplasty . Compression fractures . Implants Abbreviations BKP Balloon kyphoplasty VB Vertebral body VP Vertebroplasty VAS Visual analog score ODS Ostwestery disability score VBS Vertebral body stent The treatment of vertebral compression fractures is commonly performed using vertebroplasty or kyphoplasty techniques. Many variations of both techniques exist including different types of needles, balloons, and channel creating devices as well as different types of cements. Regardless of the technique used, excellent pain relief and a very low complication rate have been reported. Background and biomechanicsMore specifically, multiple new devices have been recently introduced for vertebral augmentation, the so-called third Key Points 1. Describe different types of vertebral implants available for treatment of spinal compression fractures 2. Outline published clinical data for each implant 3. Summarize the pros and cons of this new technique, the so called third generation vertebroplasty 4. Outline future role in treatment of traumatic and malignant lesions * Bassem A. Georgy

Therapeutic Efficacy of Third-Generation Percutaneous Vertebral Augmentation System (PVAS) in Osteoporotic Vertebral Compression Fractures (OVCFs): A Systematic Review and Meta-analysis

“…The application of the third-generation PVAS in OVCFs has expanded enormously during the last decade [ 46 – 50 ]. Although the facilities of each system are different, all of them are characterized by implanting permanent expandable devices to hydraulically or mechanically control reduction of the vertebral fracture and the sagittal balance of the spine [ 48 , 49 ]. Due to the lack of mechanical reduction ability of PVP, the recovery of vertebral height depends on intraoperative posture or the use of stents to induce scoliosis.…”

“…Thoracic fractures are often referred to as kyphotic fractures for being associated kyphotic spinal angulation, which lead to the center of gravity being shifted more anteriorly, increasing the lever arm of the forces and the forward bending moments on the already fragile spine. These mechanical changes often result in a further compression of the fractured vertebral but also put adjacent vertebrae at a higher risk of developing new fractures [ 48 ]. Although it is still controversial whether these adjacent fractures are due to the surgical procedure or natural evolution, obtaining and maintaining a more adequate reduction via these expandable implants is essential to prevent the domino effect, which is the consecutive occurrence of OVCFs in adjacent vertebrae due to excessive anterior overload after the first uncorrected wedge-shaped vertebral body [ 54 ].…”

Lumbar Spine Posttherapeutic Imaging

“…The advantages of VA over PV include better kyphosis correction and a decreased risk of cement extravertebral leakage. 1…”

“…The second is performed with a jack implant to restore vertebral height and alignment. 1 Many variations of both techniques exist with different types of devices as well as different types of cements.…”

“…It can be associated with a posterior percutaneous synthesis (►Fig. 1). Nevertheless, VA is indicated in all the other cases when PV can be applied as well.…”