Kyphoplasty, Vertebroplasty, Vertebral Augmentation Implant: Treatments for Spinal Compression Fractures

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Osteoporosis is a disease that gradually weakens bones and increases the risk for fractures (eg, spine, wrist, hip).Osteoporosis and osteopenia affects an estimated 54 million Americans, according to the National Osteoporosis Foundation.1 Left untreated, osteoporosis can progress silently and painlessly until a bone breaks.

Along with hip and wrist fractures, severe osteoporosis can cause compression fractures in the spine. This occurs when the bony block, or vertebral body, in the spine collapses. This causes severe pain, deformity, and loss of height. It can also lead to nerve compression.
Illustration of a vertebral fractureA vertebral fracture can develop suddenly in conjunction with a fall or occur as a result of osteoporosis. In some cases, a spinal fracture causes spinal cord and/or nerve compression.Compression fractures occur in more than 750,000 patients per year in the United States, are more frequent than hip fractures, and often result in prolonged disability.

Until recently, doctors were limited in how they could treat osteoporosis-related spine fractures. Pain medications, bed rest, bracing or invasive spinal surgery were the only options available. Today there are two promising therapeutic and preventive treatments for compression fractures. They are called vertebroplasty and kyphoplasty.

Vertebral Augmentation Implant
A newer type of vertebral augmentation system is now performed that is different from vertebroplasty and kyphoplasty. This minimally invasive treatment for thoracic and lumbar spinal compression fractures utilizes a continuous loop-like spinal implant. Like other procedures, it is performed using image-guidance. During the percutaneous (through the skin) procedure, the implant is delivered through a small, single incision. After the implant is in place, bone cement is injected and the implant is removed.

The procedure offers many benefits, including:

  • Reduced rate of adjacent level fracture (eg, new fracture above or below the existing fracture)
  • Improved kyphotic angle restoration
  • Reduced rate of cement leakage
  • Reduced amount of cement needed

Kyphoplasty is a newer treatment for patients immobilized by the painful vertebral body compression fractures associated with osteoporosis. Like vertebroplasty, kyphoplasty is a minimally invasive procedure that can alleviate up to 90% of the pain caused by compression fractures. In addition to relieving pain, kyphoplasty can also stabilize the fracture, restore height, and reduce deformity.

How is Kyphoplasty Performed?
Kyphoplasty is performed under local or general anesthesia. Using image guidance x-rays, two small incisions are made and a probe is placed into the vertebral space where the fracture is located. The bone is drilled and a balloon, called a bone tamp, is inserted on each side. These balloons are then inflated with contrast medium (to be seen using image guidance x-rays) until they expand to the desired height and removed. The balloon does not remain in the patient. It simply creates a cavity for the cement and also helps expand the compressed bone.

The spaces created by the balloons are then filled with PMMA, the same orthopaedic cement used in vertebroplasty, binding the fracture. The cement hardens quickly, providing strength and stability to the vertebra, restoring height, and relieving pain.

Vertebroplasty was originally developed in France in 1986 and has been further refined and available in the US since 1991.

Vertebroplasty is a minimally invasive procedure that is designed to relieve the pain of compression fractures. In addition to relieving pain, those vertebral bodies that are weakened but not yet fractured can be strengthened, thus preventing future problems.

How is Vertebroplasty Performed?
Under general anesthesia, or sometimes light sedation, a special bone needle is passed slowly through the soft tissues of the back. Image guided x-ray, along with a small amount of x-ray dye, allows the position of the needle to be seen at all times. A small amount of orthopaedic cement, called polymethylmethacrylate (PMMA), is pushed through the needle into the vertebral body. PMMA is a medical grade bone cement that has been used for many years in a variety of orthopaedic procedures.

The cement is sometimes mixed with an antibiotic to reduce the risk of infection, and a powder containing barium or tantalum, which allows it to be seen on the x-ray. When the cement is injected, it is like a thick paste, but it hardens rapidly. Usually each vertebral body is injected on both the right and left sides, just off the midline of the back. Within a few hours, patients are up and moving around. Most go home the same day.

Benefits of Vertebral Augmentation Implant, Kyphoplasty, Vertebroplasty
Limitations in the traditional treatments of vertebral compression fractures have led to the refinement of such procedures as vertebral augmentation, kyphoplasty, and vertebroplasty. These procedures provide options for compression fractures and are designed to relieve pain, reduce and stabilize fractures, reduce spinal deformity, and stop the “downward spiral” of untreated osteoporosis.

Additional benefits of these procedures include:

  • Short surgical time
  • Only general or local anesthesia required
  • Average hospital stay is one day (or less)
  • Patients can quickly return to the normal activities of daily living
  • No bracing required

Commentary by Edward C. Benzel, MD

Doctor Abitbol has provided a short and concise treatise on the subject of vertebroplasty and kyphoplasty. These two management strategies are becoming increasingly popular for the management of vertebral osteoporotic compression fractures that are refractory to medical management. Controversy often exists in medicine. This area is no exception. Dr. Abitbol however, has clarified the issues at hand while providing an excellent informative article.

Updated on: 06/26/18
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Edward C. Benzel, MD
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Cleveland Clinic Department of Neurosurgery
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