Vertebroplasty and kyphoplasty: a comparative review of efficacy and adverse events

Todd McCall, Chad Cole, Andrew Dailey, Todd McCall, Chad Cole, Andrew Dailey

Abstract

Vertebroplasty and kyphoplasty have become common surgical techniques for the treatment of vertebral compression fractures. Vertebroplasty involves the percutaneous injection of bone cement into the cancellous bone of a vertebral body with the goals of pain alleviation and preventing further loss of vertebral body height. Kyphoplasty utilizes an inflatable balloon to create a cavity for the cement with the additional potential goals of restoring height and reducing kyphosis. Vertebroplasty and kyphoplasty are effective treatment options for the reduction of pain associated with vertebral body compression fractures. Biomechanical studies demonstrate that kyphoplasty is initially superior for increasing vertebral body height and reducing kyphosis, but these gains are lost with repetitive loading. Complications secondary to extravasation of cement include compression of neural elements and venous embolism. These complications are rare but more common with vertebroplasty. Vertebroplasty and kyphoplasty are both safe and effective procedures for the treatment of vertebral body compression fractures.

Figures

Fig. 1
Fig. 1
Preoperative (a) and postoperative (b) roentgenograms of a 63-year-old patient who underwent kyphoplasty of a T12 compression fracture. The anterior vertebral height increased 4 mm and the kyphotic deformity decreased 5.6°

References

    1. Dickman CA, Fessler RG, MacMillan M, et al. Transpedicular screw-rod fixation of the lumbar spine: operative technique and outcome in 104 cases. J Neurosurg. 1992;77:860–70.
    1. Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33:166–8.
    1. McGraw JK, Lippert JA, Minkus KD, et al. Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up. J Vasc Interv Radiol. 2002;13:883–6. doi: 10.1016/S1051-0443(07)61770-9.
    1. Zoarski GH, Snow P, Olan WJ, et al. Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol. 2002;13:139–48. doi: 10.1016/S1051-0443(07)61930-7.
    1. Atalay B, Caner H, Gokce C, et al. Kyphoplasty: 2 years of experience in a neurosurgery department. Surg Neurol. 2005;64(Suppl 2):S72–6. doi: 10.1016/j.surneu.2005.07.039.
    1. Burton AW, Mendel E. Vertebroplasty and kyphoplasty. Pain Physician. 2003;6:335–41.
    1. Kaemmerlen P, Thiesse P, Jonas P, et al. Percutaneous injection of orthopedic cement in metastatic vertebral lesions. N Engl J Med. 1989;321:121.
    1. Tschirhart CE, Finkelstein JA, Whyne CM. Optimization of tumor volume reduction and cement augmentation in percutaneous vertebroplasty for prophylactic treatment of spinal metastases. J Spinal Disord Tech. 2006;19:584–90. doi: 10.1097/01.bsd.0000211236.76093.b0.
    1. Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine. 2001;26:1631–8. doi: 10.1097/00007632-200107150-00026.
    1. Cooper C, Atkinson EJ, O’Fallon WM, et al. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res. 1992;7:221–7.
    1. Silverman SL. The clinical consequences of vertebral compression fracture. Bone. 1992;13(Suppl 2):S27–31. doi: 10.1016/8756-3282(92)90193-Z.
    1. Melton LJ, 3rd, Kan SH, Frye MA, et al. Epidemiology of vertebral fractures in women. Am J Epidemiol. 1989;129:1000–11.
    1. Riggs BL, Melton LJ., 3rd The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. 1995;17:505S–11S. doi: 10.1016/8756-3282(95)00258-4.
    1. Gaughen JR, Jr, Jensen ME, Schweickert PA, et al. Relevance of antecedent venography in percutaneous vertebroplasty for the treatment of osteoporotic compression fractures. Am J Neuroradiol. 2002;23:594–600.
    1. Burton AW, Rhines LD, Mendel E. Vertebroplasty and kyphoplasty: a comprehensive review. Neurosurg Focus. 2005;18:e1. doi: 10.3171/foc.2005.18.3.2.
    1. Phillips FM, Ho E, Campbell-Hupp M, et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine. 2003;28:2260–7. doi: 10.1097/01.BRS.0000085092.84097.7B.
    1. Leech JA, Dulberg C, Kellie S, et al. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis. 1990;141:68–71.
    1. Schlaich C, Minne HW, Bruckner T, et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int. 1998;8:261–7. doi: 10.1007/s001980050063.
    1. Kado DM, Browner WS, Palermo L, et al. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1999;159:1215–20. doi: 10.1001/archinte.159.11.1215.
    1. Rapado A. General management of vertebral fractures. Bone. 1996;18:191S–6S. doi: 10.1016/8756-3282(95)00501-3.
    1. Reginster J, Minne HW, Sorensen OH, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int. 2000;11:83–91. doi: 10.1007/s001980050010.
    1. Palombaro KM. Effects of walking-only interventions on bone mineral density at various skeletal sites: a meta-analysis. J Geriatr Phys Ther. 2005;28:102–7.
    1. Khosla S, Riggs BL. Treatment options for osteoporosis. Mayo Clin Proc. 1995;70:978–82.
    1. Baker LL, Goodman SB, Perkash I, et al. Benign versus pathologic compression fractures of vertebral bodies: assessment with conventional spin-echo, chemical-shift, and STIR MR imaging. Radiology. 1990;174:495–502.
    1. Maynard AS, Jensen ME, Schweickert PA, et al. Value of bone scan imaging in predicting pain relief from percutaneous vertebroplasty in osteoporotic vertebral fractures. Am J Neuroradiol. 2000;21:1807–12.
    1. Amar AP, Larsen DW, Esnaashari N, et al. Percutaneous transpedicular polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures. Neurosurgery. 2001;49:1105–15. doi: 10.1097/00006123-200111000-00017.
    1. Barr JD, Barr MS, Lemley TJ, et al. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine. 2000;25:923–8. doi: 10.1097/00007632-200004150-00005.
    1. Cotten A, Boutry N, Cortet B, et al. Percutaneous vertebroplasty: state of the art. Radiographics. 1998;18:311–23.
    1. Peters KR, Guiot BH, Martin PA, et al. Vertebroplasty for osteoporotic compression fractures: current practice and evolving techniques. Neurosurgery. 2002;51:S96–103. doi: 10.1097/00006123-200211002-00014.
    1. Weill A, Chiras J, Simon JM, et al. Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology. 1996;199:241–7.
    1. Kim AK, Jensen ME, Dion JE, et al. Unilateral transpedicular percutaneous vertebroplasty: initial experience. Radiology. 2002;222:737–41. doi: 10.1148/radiol.2223010718.
    1. Molloy S, Riley LH, 3rd, Belkoff SM. Effect of cement volume and placement on mechanical-property restoration resulting from vertebroplasty. Am J Neuroradiol. 2005;26:401–4.
    1. Steinmann J, Tingey CT, Cruz G, et al. Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine. 2005;30:201–5. doi: 10.1097/01.brs.0000150831.46856.87.
    1. McGraw JK, Heatwole EV, Strnad BT, et al. Predictive value of intraosseous venography before percutaneous vertebroplasty. J Vasc Interv Radiol. 2002;13:149–53. doi: 10.1016/S1051-0443(07)61931-9.
    1. Vasconcelos C, Gailloud P, Beauchamp NJ, et al. Is percutaneous vertebroplasty without pretreatment venography safe? Evaluation of 205 consecutives procedures. Am J Neuroradiol. 2002;23:913–7.
    1. Belkoff SM, Mathis JM, Deramond H, et al. An ex vivo biomechanical evaluation of a hydroxyapatite cement for use with kyphoplasty. Am J Neuroradiol. 2001;22:1212–6.
    1. Belkoff SM, Mathis JM, Jasper LE. Ex vivo biomechanical comparison of hydroxyapatite and polymethylmethacrylate cements for use with vertebroplasty. Am J Neuroradiol. 2002;23:1647–51.
    1. Jasper LE, Deramond H, Mathis JM, et al. Material properties of various cements for use with vertebroplasty. J Mater Sci Mater Med. 2002;13:1–5. doi: 10.1023/A:1013673830184.
    1. Jensen ME, Evans AJ, Mathis JM, et al. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. Am J Neuroradiol. 1997;18:1897–904.
    1. Mathis JM, Petri M, Naff N. Percutaneous vertebroplasty treatment of steroid-induced osteoporotic compression fractures. Arthritis Rheum. 1998;41:171–5. doi: 10.1002/1529-0131(199801)41:1<171::AID-ART21>;2-5.
    1. Perry A, Mahar A, Massie J, et al. Biomechanical evaluation of kyphoplasty with calcium sulfate cement in a cadaveric osteoporotic vertebral compression fracture model. Spine J. 2005;5:489–93. doi: 10.1016/j.spinee.2005.03.011.
    1. Tomita S, Kin A, Yazu M, et al. Biomechanical evaluation of kyphoplasty and vertebroplasty with calcium phosphate cement in a simulated osteoporotic compression fracture. J Orthop Sci. 2003;8:192–7. doi: 10.1007/s007760300032.
    1. Tomita S, Molloy S, Jasper LE, et al. Biomechanical comparison of kyphoplasty with different bone cements. Spine. 2004;29:1203–7. doi: 10.1097/00007632-200406010-00009.
    1. Wilke HJ, Mehnert U, Claes LE, et al. Biomechanical evaluation of vertebroplasty and kyphoplasty with polymethyl methacrylate or calcium phosphate cement under cyclic loading. Spine. 2006;31:2934–41. doi: 10.1097/01.brs.0000248423.28511.44.
    1. Belkoff SM, Mathis JM, Jasper LE, et al. The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior. Spine. 2001;26:1537–41. doi: 10.1097/00007632-200107150-00007.
    1. Kim MJ, Lindsey DP, Hannibal M, et al. Vertebroplasty versus kyphoplasty: biomechanical behavior under repetitive loading conditions. Spine. 2006;31:2079–84. doi: 10.1097/01.brs.0000231714.15876.76.
    1. Taylor RS, Taylor RJ, Fritzell P. Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine. 2006;31:2747–55. doi: 10.1097/01.brs.0000244639.71656.7d.
    1. Fourney DR, Schomer DF, Nader R, et al. Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg. 2003;98:21–30.
    1. Kasperk C, Hillmeier J, Noldge G, et al. Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study. J Bone Miner Res. 2005;20:604–12. doi: 10.1359/JBMR.041203.
    1. Hulme PA, Krebs J, Ferguson SJ, et al. Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine. 2006;31:1983–2001. doi: 10.1097/01.brs.0000229254.89952.6b.
    1. Berlemann U, Franz T, Orler R, et al. Kyphoplasty for treatment of osteoporotic vertebral fractures: a prospective non-randomized study. Eur Spine J. 2004;13:496–501. doi: 10.1007/s00586-004-0691-7.
    1. Chiras J, Depriester C, Weill A, et al. Percutaneous vertebral surgery. Technics and indications. J Neuroradiol. 1997;24:45–59.
    1. Mathis JM, Barr JD, Belkoff SM, et al. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. Am J Neuroradiol. 2001;22:373–81.
    1. Lee BJ, Lee SR, Yoo TY. Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate: a case report. Spine. 2002;27:E419–22. doi: 10.1097/00007632-200210010-00022.
    1. Ratliff J, Nguyen T, Heiss J. Root and spinal cord compression from methylmethacrylate vertebroplasty. Spine. 2001;26:E300–2. doi: 10.1097/00007632-200107010-00021.
    1. Chen HL, Wong CS, Ho ST, et al. A lethal pulmonary embolism during percutaneous vertebroplasty. Anesth Analg. 2002;95:1060–2. doi: 10.1097/00000539-200210000-00049.
    1. Jang JS, Lee SH, Jung SK. Pulmonary embolism of polymethylmethacrylate after percutaneous vertebroplasty: a report of three cases. Spine. 2002;27:E416–8. doi: 10.1097/00007632-200210010-00021.
    1. Tozzi P, Abdelmoumene Y, Corno AF, et al. Management of pulmonary embolism during acrylic vertebroplasty. Ann Thorac Surg. 2002;74:1706–8. doi: 10.1016/S0003-4975(02)03962-0.
    1. Nussbaum DA, Gailloud P, Murphy K. A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site. J Vasc Interv Radiol. 2004;15:1185–92.
    1. Walker DH, Mummaneni P, Rodts GE. Infected vertebroplasty. Report of two cases and review of the literature. Neurosurg Focus. 2004;17:E6. doi: 10.3171/foc.2004.17.2.2.
    1. Phillips FM, Todd Wetzel F, Lieberman I, et al. An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty. Spine. 2002;27:2173–9. doi: 10.1097/00007632-200210010-00018.
    1. Cortet B, Cotten A, Boutry N, et al. Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol. 1999;26:2222–8.
    1. Fribourg D, Tang C, Sra P, et al. Incidence of subsequent vertebral fracture after kyphoplasty. Spine. 2004;29:2270–7. doi: 10.1097/01.brs.0000142469.41565.2a.
    1. Grados F, Depriester C, Cayrolle G, et al. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 2000;39:1410–4. doi: 10.1093/rheumatology/39.12.1410.
    1. Kim SH, Kang HS, Choi JA, et al. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol. 2004;45:440–5. doi: 10.1080/02841850410005615.
    1. Lin EP, Ekholm S, Hiwatashi A, et al. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. Am J Neuroradiol. 2004;25:175–80.
    1. Uppin AA, Hirsch JA, Centenera LV, et al. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology. 2003;226:119–24. doi: 10.1148/radiol.2261011911.
    1. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. J Am Med Assoc. 2001;285:320–3. doi: 10.1001/jama.285.3.320.
    1. Perez-Higueras A, Alvarez L, Rossi RE, et al. Percutaneous vertebroplasty: long-term clinical and radiological outcome. Neuroradiology. 2002;44:950–4. doi: 10.1007/s00234-002-0856-1.
    1. Melton LJ, 3rd, Atkinson EJ, Cooper C, et al. Vertebral fractures predict subsequent fractures. Osteoporos Int. 1999;10:214–21. doi: 10.1007/s001980050218.
    1. Chung SK, Lee SH, Kim DY, et al. Treatment of lower lumbar radiculopathy caused by osteoporotic compression fracture: the role of vertebroplasty. J Spinal Disord Tech. 2002;15:461–8.
    1. Hentschel SJ, Burton AW, Fourney DR, et al. Percutaneous vertebroplasty and kyphoplasty performed at a cancer center: refuting proposed contraindications. J Neurosurg Spine. 2005;2:436–40.
    1. Nakano M, Hirano N, Matsuura K, et al. Percutaneous transpedicular vertebroplasty with calcium phosphate cement in the treatment of osteoporotic vertebral compression and burst fractures. J Neurosurg. 2002;97:287–93.
    1. Peh WC, Gilula LA, Peck DD. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology. 2002;223:121–6. doi: 10.1148/radiol.2231010234.
    1. Wetzel SG, Martin JB, Somon T, et al. Painful osteolytic metastasis of the atlas: treatment with percutaneous vertebroplasty. Spine. 2002;27:E493–5. doi: 10.1097/00007632-200211150-00022.
    1. Acosta FL, Jr, Aryan HE, Taylor WR, et al. Kyphoplasty-augmented short-segment pedicle screw fixation of traumatic lumbar burst fractures: initial clinical experience and literature review. Neurosurg Focus. 2005;18:e9.
    1. Cho DY, Lee WY, Sheu PC. Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation. Neurosurgery. 2003;53:1354–61. doi: 10.1227/01.NEU.0000093200.74828.2F.
    1. Sarzier JS, Evans AJ, Cahill DW. Increased pedicle screw pullout strength with vertebroplasty augmentation in osteoporotic spines. J Neurosurg. 2002;96:309–12.
    1. Gerszten PC, Germanwala A, Burton SA, et al. Combination kyphoplasty and spinal radiosurgery: a new treatment paradigm for pathological fractures. Neurosurg Focus. 2005;18:e8.

Source: PubMed

3
Subscribe