Vertebroplasty for osteoporotic spine fracture: prevention and treatment

Abstract

IntroductionOsteoporosis is a disorder of decreased bone mass, microstructural collapse, and fragility fractures. It can affect people of all ethnic backgrounds and can result in challenging complications, ranging from compression fractures of vertebral bodies to femoral neck fractures [59]. The geriatric population is especially at risk for such osteoporotic fractures, as bone mass decreases with age [53]. A loss of one standard deviation of bone mass doubles the risk of spine fractures [34,56,59]. It is estimated that 90% of hip and spine fractures occurring in the elderly are attributable to osteoporosis [45]. The consequences of such osteoporotic vertebral fractures are diverse and include back pain, functional limitations and impairment of mood [11,37,58].A recent study in Canada examined the health-related quality of life (HRQL) in women aged 50 years and older with osteoporosis [1]. Subjects who had experienced a vertebral fracture had lower HRQL scores than participants without fracture in total score, symptoms, physical function, activities of daily living, and leisure. Acute complications of osteoporotic vertebral fractures include transient ileus, urinary retention, nausea, abdominal pain and chest pain [41,49]. Long-term effects of osteoporotic fracAbstract There is a relatively high prevalence of osteoporotic vertebral compression fractures (VCFs) in the elderly population, especially in women aged 50 or older. The result of these VCFs is increased morbidity and mortality in the short and long term. Medical treatment of these fractures includes bed rest, orthotics, analgesic medication and time. Percutaneous vertebroplasty (PVP) consists of percutaneous injection of biomaterial, such as methylmethacrylate, into the VCF to produce stability and pain relief. Biomechanical testing has shown that PVP can restore strength and stiffness of the vertebral body to the pre-fracture levels. Clinical results show immediate and maintained pain relief in 70-95% of the patients. Possible major complications include cement leakage into the spinal canal or into the venous system. Additionally, percutaneous vertebroplasty may alter the normal loading behavior of the adjacent vertebral body, and there is an increased risk of adjacent segment VCF. Kyphoplasty is a new technique, which introduces a balloon into the vertebral body transpedicularly to reduce the VCF while creating a cavity for the cement injection. This technique has the benefit of kyphosis reduction as well as less cement leakage. Research continues into the development of injectable biomaterials that are resorbable and allow for new bone formation. Vertebroplasty and kyphoplasty are safe and effective in the treatment of osteoporotic VCFs. They may allow for a faster return to function, and thus avoid the morbidity associated with medical treatment.

Percutaneous vertebroplasty: the follow-up

“…Patients treated with the procedure reported complete or partial pain relief immediately after the procedure: 24 h after in 88% of cases of osteoporotic fractures and in 84% of cases of neoplastic fractures. These data confirm the high success rates reported by other authors [4,5,[18][19][20][21]. No patient reported pain worsening, whereas patients who failed to benefit significantly from the procedure were affected by fractures more than 6 months old.…”

“…I pazienti che abbiamo sottoposto alla procedura hanno riferito la scomparsa o la significativa riduzione del dolore immediatamente dopo la procedura e dopo 24 ore nel 88% dei casi quando colpiti da crollo osteoporotico, e nel 84% quando affetti da localizzazione neoplastica. Questi dati confermano quelli di altri autori riportanti alte percentuali di successo [4,5,[18][19][20][21]. In nessun soggetto si è avuto un peggioramento della sintomatologia, mentre i pazienti che non hanno tratto sollievo in maniera significativa dal trattamento erano affetti da fratture datate oltre sei mesi.…”

Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

“…The pain and fracture kyphosis can compromise respiratory function [38,40,51]. Many patients sustain serious cardiovascular, musculoskeletal, metabolic, and immune complications related to immobility and bedrest [9,43]. Patients typically affected by VCF often cannot tolerate the complications of nonoperative care.…”

Sacral kyphoplasty for relieving pain caused by sacral hemangioma

“…Then, polymethylmethacrylate (PMMA), a cement-like material, is injected into the void to stabilize the fracture, decrease or eliminate pain, and prolong functional survival. [9][10][11][12][13][14] Kyphoplasty has been used from the midthoracic region down to the L5 level. [3][4][5][6][7][8] However, experience with these methods in the sacrum is very limited.…”