Verteroplasty and kyphoplasty for vertebral compression fractures

NICE state that:

• percutaneous vertebroplasty, and percutaneous balloon kyphoplasty without stenting, are recommended as options for treating osteoporotic vertebral compression fractures only in people:
  • who have severe ongoing pain after a recent, unhealed vertebral fracture despite optimal pain management and
  • in whom the pain has been confirmed to be at the level of the fracture by physical examination and imaging

Percutaneous vertebroplasty

• vertebroplasty involves injecting bone cement, typically polymethylmethacrylate, into the vertebral body (the solid part of the vertebra), using local anaesthetic and an analgesic. Vertebroplasty aims to relieve pain in people with painful fractures and to strengthen the bone to prevent future fractures

Percutaneous balloon kyphoplasty without stenting

• kyphoplasty involves inserting a balloon-like device (tamps) into the vertebral body, using local or general anaesthetic. The balloon is slowly inflated until it restores the normal height of the vertebral body or the balloon reaches its highest volume. When the balloon is deflated, the space is filled with bone cement, and a stent may or may not be placed
• kyphoplasty aims to reduce pain and curvature of the spine

Percutaneous balloon kyphoplasty with stenting

• kyphoplasty with stenting involves inserting a small balloon catheter surrounded by a metal stent into the vertebral body using radiographic guidance and either local or general anaesthesia. The balloon catheter is inflated with liquid under pressure to create a space into which the stent is expanded. The balloon catheter is deflated and withdrawn, but the stent remains in the vertebral cavity into which high-viscosity polymethylmethacrylate bone cement is then injected. The stent's function is to prevent the vertebra from losing height after the balloon is deflated

Adverse reactions

• for both vertebroplasty and kyphoplasty, adverse reactions can be caused by:
  • needle insertion (such as local or systemic infection, bleeding and damage to neural or other structures)
  • leakage of bone cement
  • displacement of bone marrow and other material by the cement
  • systemic reactions to the cement (such as hypotension and death);
  • complications related to anaesthesia and patient positioning (such as additional fractures of a rib or the sternum)
  • there is a small risk that the balloon can rupture in kyphoplasty, which can result in the retention of balloon fragments within the vertebral body

Reference:

• NICE (April 2013). Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures