Do the Benefits of Vertebroplasty and Kyphoplasty Outweigh the Risks?Vertebral compression fractures (VCFs) are a bad deal all the way around. They cause pain, disability, and even death. The patient can end up with a stooped posture, which then cuts down on their air flow and lung function. The pain keeps them on the couch, in the recliner, or in bed. The resultant immobility can put the person at risk for pneumonia and deadly blood clots.
Compression fractures are the most common type of fracture affecting the spine. A compression fracture of a spine bone (vertebra) causes the bone to collapse in height. Compression fractures are commonly the result of osteoporosis.
About 750,000 cases of compression fractures due to osteoporosis occur each year in the United States. Spine bones that are weakened from osteoporosis may become unable to support normal stress and pressure. As a result, something as simple as coughing, twisting, or lifting can cause a vertebra to fracture.
In this review article, orthopedic surgeons bring us up-to-date on the latest research on the role and effectiveness of vertebroplasty and kyphoplasty. These procedures are used when painful symptoms develop as a result of vertebral compression fractures. The treatment can be done early on to help prevent further complications such as pneumonia or loss of function due to the pain.
To perform a vertebroplasty, the surgeon uses a fluoroscope to guide a needle into the fractured vertebral body. A fluoroscope is a special X-ray television that allows the surgeon to see your spine and the needle as it moves. Once the surgeon is sure the needle is in the right place, a special bone cement is injected through the needle into the fractured vertebra. A reaction in the cement causes it to harden very quickly. This fixes the bone so that it does not collapse any further as it heals.
Kyphoplasty is another way for surgeons to treat vertebral compression fractures. Like vertebroplasty, this procedure halts severe pain and strengthens the fractured bone. However, it also gives the advantage of improving some or all of the lost height in the vertebral body, helping prevent kyphosis.
Two long needles are inserted through the sides of the spinal column into the fractured vertebral body. These needles guide the surgeon while drilling two holes into the vertebral body. The surgeon uses a fluoroscope to make sure the needles and drill holes are placed in the right spot.
The surgeon then slides a hollow tube with a deflated balloon on the end through each drill hole. Inflating the balloons restores the height of the vertebral body and corrects the kyphosis deformity. Before the procedure is complete, the surgeon removes the balloon and then injects bone cement into the hollow space formed by the balloon. This fixes the bone in its corrected size and position.
These two procedures have been around long enough now to have some research data on how well they are working. Stabilizing the fractured vertebral body seems to provide the pain relief needed. Up to 95 percent of patients get immediate pain relief with this treatment. The vertebroplasty or kyphoplasty restores spinal stiffness and increases spine strength needed for pain free stability.
But complications such as fever and cement leaking out have been reported. The oozing cement can put pressure on the spinal cord or nearby nerves or even travel to the lungs as a cement clot (embolism). There have been some studies showing that patients can develop other fractures in the adjacent vertebrae. But whether these new fractures are a result of the osteoporosis that caused the first vertebral compression fractures or perhaps the result of the vertebroplasty or kyphoplasty is unknown.
Long-term studies now available show that the results don't last. And recovery is about the same when compared with patients who were treated conservatively with physical therapy, postural exercises, and pain relievers. The main difference is how quickly pain relief is delivered: immediately with vertebroplasty versus two to four weeks later with nonoperative care.
For patients in acute pain and in danger of lung compromise, vertebroplasty is a safe procedure that can provide immediate results. But to use either vertebroplasty or kyphoplasty on a routine basis for every compression fracture isn't advised.
There have been enough studies comparing vertebroplasty with a sham treatment and no difference in results to slow down the routine use of the vertebroplasty procedure. It's likely that the benefits of vertebroplasty/kyphoplasty were over estimated early on.
The true value of either procedure is more apparent now. There are still some patients who can really benefit from these procedures. But more studies are needed to identify exactly who those patients are so that surgeons can administer the treatment to the right people at the right time for the best results.
Vishal C. Patel and Franco P. Cerabona, MD. The Role of Vertebroplasty and Kyphoplasty for the Treatment of Osteoporotic Compression Fractures. In Current Orthopaedic Practice. July/August 2010. Vol. 21. No. 4. Pp. 375-377.
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