Vertebral body reconstruction: Review and update on vertebroplasty and kyphoplasty by ProQuest


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									Vertebral body reconstruction:
Review and update on
vertebroplasty and kyphoplasty

A. Orlando Ortiz, MD, MBA, FACR

          ertebroplasty is an invasive
          spine procedure that involves
          the injection of bone cement
under fluoroscopic or computed tomo-
graphic (CT) guidance into a vertebral
body that has been damaged as a result of
either an osteoporotic vertebral compres-
sion fracture or neoplastic infiltration.
Kyphoplasty, a derivative of vertebro-
plasty, entails the temporary placement
and subsequent inflation of balloon
tamps within the vertebral body prior to
cement deposition. Vertebroplasty was
first performed in 1984, while kypho-
plasty was first performed more than a             The vast majority of osteoporotic ver-    A primary goal of vertebral augmenta-
decade later in 1998.1-3 Both procedures       tebral compression fractures occur           tion, therefore, is to stabilize the frac-
have quickly become established as effi-        within the thoracic and lumbar spine,        tured vertebra, reinforcing the anterior
cacious treatments for patients experi-        particularly at the thoracolumbar junc-      column and any endplate fractures,
encing back pain related to osteoporotic       tion. The fracture destabilizes the verte-   thereby alleviating pain. Another pri-
or pathologic vertebral compression            bral body, and macro- and micromotion        mary goal is to try to restore, as much as
fractures.4 This article will not only         at the fracture site causes pain. These      possible, spinal alignment and function
review these procedures, but will also         fractures impact on the normal biome-        to the prefracture status by restoring the
discuss the rationale for the clinical util-   chanical alignment of the spine by caus-     vertebral body height, reducing angula-
ity of vertebral body augmentation or          ing the patient’s center of gravity to       tion at the fracture level, and minimizing
reconstruction, review the clinical expe-      move forward and, thus, simultaneously       kyphotic deformity. A secondary objec-
rience with vertebroplasty and kypho-          creating a large anterior bending mo-        tive of these procedures is to prevent
plasty, and discuss advances in the field       ment.5 This alteration has significant       further vertebral body height loss. Not
of vertebral body reconstruction. Finally,     adverse sequelae in that it places addi-     only is this associated with progressive
this article will emphasize the active role    tional stress on the posterior paraspinal    kyphosis, but it is also associated with
of the radiologist in the management of        muscles and ligaments, predisposes to a      fractures at adjacent levels. The odds
patients who present with vertebrogenic        loss of balance, and places additional       ratio for the development of new verte-
back pain, both prior to and after their       stress on the anterior column such that      bral compression fractures increases to
fractures have been treated.                   adjacent and other vertebrae are at risk     20.6 when the patient’s actual height
                                               for compression. Longitudinal studies        decreases >4 cm.7
 Dr. Ortiz is a Professor and Chairman,        have shown that in the absence of any           With >700,000 osteoporotic verte-
 Department of Radiology, Winthrop-            treatment the subsequent fracture risk in    bral compression fractures occurring
 University Hospital, Mineola, NY.             a patient with an osteoporotic vertebral     each year in the United States alone, it
                                               fracture is 20% within the first year.6      must be kept in mind that not all of

10   ■     APPLIED RADIOLOGY     ©
                                                                                     December 2008
                                                                                            VERTEBROPLASTY AND KYPHOPLASTY

   A                                                  B                                             C

                                                                                                           FIGURE 1. An 86-year-old woman
                                                                                                           presented with a recent history of
     D                                                              E                                      severe low back pain. (A) A lateral
                                                                                                           radiograph of the lumbar spine shows
                                                                                                           L1 and L2 vertebral compression
                                                                                                           deformities (arrows). (B) A T1-
                                                                                                           weighted sagittal MR image shows
                                                                                                           hypointense signal throughout the L1
                                                                                                           vertebral body and within the superior
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