Vertebroplasty was first performed in 1984, while kyphoplasty was first performed more than a decade later in 1998.1-3 Both procedures have quickly become established as effi- cacious treatments for patients experiencing back pain related to osteoporotic or pathologic vertebral compression fractures.4 This article will not only review these procedures, but will also discuss the rationale for the clinical utility of vertebral body augmentation or reconstruction, review the clinical experience with vertebroplasty and kyphoplasty, and discuss advances in the field of vertebral body reconstruction. Skeletal scintigraphy can be used to identify acute or subacute vertebral compression fractures.\n The objective of these hybrid therapies is to reduce the tumor volume and facilitate cement injection for stabilization.35 Postprocedure Patient Management Vertebral body reconstruction techniques are quickly evolving; nevertheless, vertebroplasty and kyphoplasty remain established procedures for the treatment of painful vertebral compression fractures.
Vertebral body reconstruction: Review and update on vertebroplasty and kyphoplasty A. Orlando Ortiz, MD, MBA, FACR V 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 © www.appliedradiology.com 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
Pages to are hidden for
"Vertebral body reconstruction: Review and update on vertebroplasty and kyphoplasty"Please download to view full document