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Vertebroplasty and Kyphoplasty

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Abstract

Vertebral compression fractures (VCFs) are a common complication of osteoporosis. They are variably symptomatic, and many can be well managed with conservative treatments such as analgesia, orthotic bracing or bed rest. However, in a subset population of patients, back pain will persist despite a trial of conservative management or will be severe enough to require high doses of narcotic analgesia or hospitalization. In these patients, vertebral augmentation procedures appear to provide substantial benefit. Augmentation may also be performed for patients with painful VCFs due to spinal metastases or primary spinal neoplasms. Vertebral augmentation procedures, encompassing vertebroplasty and kyphoplasty, involve the percutaneous, image-guided infiltration of cement into the fractured vertebra. In vertebroplasty, cement is injected directly into the vertebral body, while balloon kyphoplasty includes a further step in which a tamp is inflated to create a bony cavity for cement injection. The goals of these procedures are the relief of back pain, enhancement of functional status and mobility and biomechanical stabilization of the vertebral body. Despite mixed results from early trials of vertebral augmentation, after positive results from recent large randomized studies, there is high-quality evidence to support the use of these procedures in acute VCFs refractory to conservative therapy. Vertebroplasty and kyphoplasty are safe procedures, with low rates of serious complications. This chapter will outline a practical guide to the patient selection, pre-procedural planning, procedural technique and after-care of vertebroplasty and kyphoplasty. The latest evidence for the efficacy and safety of these procedures is presented and reviewed.

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Author information

Authors and Affiliations

  1. Monash Health, Interventional Neuroradiology Unit, Monash Imaging, Clayton, VIC, Australia

    Nicole S. Carter

  2. Department of Radiology, Northern Hospital, Melbourne, VIC, Australia

    Hong Kuan Kok

  3. Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Melbourne, VIC, Australia

    Julian Maingard

  4. Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, VIC, Australia

    Julian Maingard

  5. Department of Radiology, Austin Health, Heidelberg, VIC, Australia

    Hamed Asadi

  6. Radiology and Biomedical Imaging, Neuroradiology Section, University of California, San Francisco, San Francisco, CA, USA

    Vinil Shah

  7. Departments of Neurosurgery and Neurology, Neuroendovascular Program and Neurocritical Care, Massachusetts General Hospital, Boston, MA, USA

    Thabele Leslie-Mazwi

  8. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Joshua A. Hirsch

  9. Department of Medicine, Surgery and Imaging, Monash Medical Centre, Diagnostic and Interventional Neuroradiology, Monash Imaging-Monash Health, Monash University, Clayton, VIC, Australia

    Ronil V. Chandra

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  1. Nicole S. Carter
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Editors and Affiliations

  1. Richard J. Kitz Professor of Anesthesia Research Harvard Medical School, Harvard University, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA

    Jianren Mao

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Carter, N.S. et al. (2020). Vertebroplasty and Kyphoplasty. In: Mao, J. (eds) Spine Pain Care. Springer, Cham. https://doi.org/10.1007/978-3-030-27447-4_26

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  • DOI: https://doi.org/10.1007/978-3-030-27447-4_26

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