Percutaneous Vertebroplasty and Balloon Kyphoplasty for the Treatment of Acute Painful Pathologic and Nonpathologic Fractures

  • Sandra Narayanan
  • Frank C. Tong
Part of the Contemporary Hematology book series (CH)


Percutaneous vertebroplasty, a procedure first performed in France in 19841 and in the United States in 1994,2 is generally used for three primary indications: osteoporotic vertebral compression fractures, malignant vertebral tumors, and painful and/or aggressive vertebral hemangiomas.3 The goal in all three scenarios is pain relief with the potential for early mobility while providing structural support of the destructive spine lesion.

Persons with destructive malignant lesions of the spine such as multiple myeloma are ideal candidates for vertebroplasty, as progressive and disproportionate bone resorption is responsible for the principal morbidity of this devastating illness. Fifty-five to seventy percent of fractures in multiple myeloma occur in the spine, most commonly in the lower thoracic or lumbar vertebrae.4 A threefold increased fracture risk (mostly pathologic fractures) is noted in patients with monoclonal gammopathy of undetermined significance (MGUS)5; this...


Vertebral Body Vertebral Compression Fracture Cement Leakage Percutaneous Vertebroplasty Vertebral Body Height 
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  1. 1.
    Galibert P, Déramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 1987;33(2):166–168.PubMedGoogle Scholar
  2. 2.
    Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HG, Dion JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol 1997;18(10):1897–1904.PubMedGoogle Scholar
  3. 3.
    Déramond H, Depriester C, Toussaint P, Galibert P. Percutaneous Vertebroplasty. Semin Musculoskelet Radiol 1997;1(2):285–296.PubMedCrossRefGoogle Scholar
  4. 4.
    Lecouvet FE, Vande Berg BC, Maldague BE, Michaux L, Laterre E,Michaux JL, Ferrant A, Malghem J. Vertebral compression fractures in multiple myeloma. Part I. distribution and appearance at MR imaging. Radiology 1997;204(1):195–199.PubMedGoogle Scholar
  5. 5.
    Melton LJ 3rd, Rajkumar SV, Khosla S, Achenbach SJ, Oberg AL, Kyle RA. Fracture risk in monoclonal gammopathy of undetermined significance. J Bone Miner Res2004;19(1):25–30.PubMedCrossRefGoogle Scholar
  6. 6.
    Melton LJ 3rd, Kyle RA, Achenbach SJ, Oberg AL, Rajkumar SV. Fracture risk with multiple myeloma: a population-based study. J Bone Miner Res2005;20(3):487–493. Epub 2004 Nov 29.PubMedCrossRefGoogle Scholar
  7. 7.
    Angtuaco EJ, Justus M, Sethi R, Analysis of compression fractures in patients with newly diagnosed multiple myeloma on comprehensive therapy (abstr). Radiology 2001;221(P):138.Google Scholar
  8. 8.
    Epstein J, Walker R. Myeloma and bone disease: “the dangerous tango”. Clin Adv Hematol Oncol2006;4(4):300–306.PubMedGoogle Scholar
  9. 9.
    Dublin AB, Hartman J, Latchaw RE, Hald JK, Reid MH. The vertebral body fracture in osteoporosis: restoration of height using percutaneous vertebroplasty. AJNR Am J Neuroradiol 2005;26(3):489–492.PubMedGoogle Scholar
  10. 10.
    Lieberman IH, Dudeney S, Reinhardt MK, Bell G. Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine2001;26(14):1631–1638.PubMedCrossRefGoogle Scholar
  11. 11.
    Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine2001;26(14):1511–1515.PubMedCrossRefGoogle Scholar
  12. 12.
    Theodorou DJ, Theodorou SJ, Duncan TD, Garfin SR, Wong WH. Percutaneous balloon kyphoplasty for the correction of spinal deformity in painful vertebral body compression fractures. Clin Imaging2002;26(1):1–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Dudeney S, Lieberman IH, Reinhardt MK, Hussein M. Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma. J Clin Oncol2002;20(9):2382–2387.PubMedCrossRefGoogle Scholar
  14. 14.
    Lieberman I, Reinhardt MK. Vertebroplasty and kyphoplasty for osteolytic vertebral collapse. Clin Orthop Relat Res2003;(415 Suppl):S176–S186.Google Scholar
  15. 15.
    Heran MK, Legiehn GM, Munk PL Current concepts and techniques in percutaneous vertebroplasty.. Orthop Clin N Am2006;37(3):409–434.CrossRefGoogle Scholar
  16. 16.
    McKiernan F, Faciszewski T. Intravertebral clefts in osteoporotic vertebral compression fractures. Arthritis Rheum2003;48(5):1414–1419.PubMedCrossRefGoogle Scholar
  17. 17.
    McKiernan F, Jensen R, Faciszewski T. The dynamic mobility of vertebral compression fractures.J Bone Miner Res2003;18(1):24–29.PubMedCrossRefGoogle Scholar
  18. 18.
    McGraw JK, Cardella J, Barr JD, Mathis JM, Sanchez O, Schwartzberg MS, Swan TL, Sacks D. Society of Interventional Radiology quality improvement guidelines for percutaneous vertebroplasty J Vasc Interv Radiol2003;14(7):827–831.PubMedCrossRefGoogle Scholar
  19. 19.
    Déramond H, Depriester C, Galibert P, Le Gars D. Percutaneous vertebroplasty with polymethylmethacrylate: technique, indications, and results Radiol Clin North Am1998;36(3):533–546.PubMedCrossRefGoogle Scholar
  20. 20.
    Weill A, Chiras J, Simon JM, Rose M, Sola-Martinez T, Enkaoua E. Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement.Radiology1996;199(1):241–247.PubMedGoogle Scholar
  21. 21.
    Cotten A, Dewatre F, Cortet B, Assaker R, Leblond D, Duquesnoy B, Chastanet P, Clarisse J. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up.Radiology1996;200(2):525–530.PubMedGoogle Scholar
  22. 22.
    Jasper LE, Déramond H, Mathis JM, Belkoff SM. Material properties of various cements for use with vertebroplasty.J Mater Sci Mater Med2002;13(1):1–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Blinc A, Bozic M, Vengust R, Stegnar M. Methyl-methacrylate bone cement surface does not promote platelet aggregation of plasma coagulation in vitroThromb Res 2004;114(3):179–184.PubMedCrossRefGoogle Scholar
  24. 24.
    Baroud G, Yahia FB. A finite element rheological model for polymethylmeth-acrylate flow: analysis of the cement delivery in vertebroplastyProc Inst Mech Eng [H]2004;218(5):331–338.Google Scholar
  25. 25.
    Belkoff SM, Molloy S. Temperature measurement during polymerization of polymeth-ylmethacrylate cement used for vertebroplasty Spine2003;28(14):1555–1559.PubMedCrossRefGoogle Scholar
  26. 26.
    Jasper LE, Déramond H, Mathis JM, Belkoff SM. The effect of monomer-to-powder ratio on the material properties of cranioplastic.Bone1999;25(2 suppl):27S–29S.PubMedCrossRefGoogle Scholar
  27. 27.
    Resnick DK, Garfin SR. Vertebroplasty and Kyphoplasty. Thieme Medical Publishers, Inc., 2005.Google Scholar
  28. 28.
    Shapiro SA. Cranioplasty, vertebral body replacement, and spinal fusion with tobramycin-impregnated methylmethacrylate.Neurosurgery1991;28(6): 789–791.PubMedCrossRefGoogle Scholar
  29. 29.
    Lautenschlager EP, Jacobs JJ, Marshall GW, Meyer PR Jr. Mechanical properties of bone cements containing large doses of antibiotic powders.J Biomed Mater Res 1976;10(6):929–938.PubMedCrossRefGoogle Scholar
  30. 30.
    Lautenschlager EP, Marshall GW, Marks KE, Schwartz J, Nelson CL. Mechanical strength of acrylic bone cements impregnated with antibiotics.J Biomed Mater Res 1976;10(6):837–845.PubMedCrossRefGoogle Scholar
  31. 31.
    Kim AK, Jensen ME, Dion JE, Schweickert PA, Kaufmann TJ, Kallmes DF. Unilateral transpedicular percutaneous vertebroplasty: initial experience.Radiology 2002;222(3):737–741.PubMedCrossRefGoogle Scholar
  32. 32.
    Lieberman IH, Togawa D, Kayanja MM. Vertebroplasty and kyphoplasty: filler materialsSpine J2005;5(6 Suppl):305S–316S.PubMedCrossRefGoogle Scholar
  33. 33.
    Jefferiss CD, Lee AJ, Ling RS. Thermal aspects of self-curing polymethylmethacr-ylate. J Bone Joint Surg Br1975;57(4):511–518.PubMedGoogle Scholar
  34. 34.
    Mousavi P, Roth S, Finkelstein J, Cheung G, Whyne C. Volumetric quantification of cement leakage following percutaneous vertebroplasty in metastatic and osteoporotic vertebrae.J Neurosurg2003;99(1 Suppl):56–69.PubMedGoogle Scholar
  35. 35.
    Belkoff SM, Mathis JM, Jasper LE. Ex vivo biomechanical comparison of hydroxyapatite and polymethylmethacrylate cements for use with vertebroplasty. AJNR Am J Neuroradiol2002;23(10):1647–1651.PubMedGoogle Scholar
  36. 36.
    Voormolen MH, Lohle PN, Lampmann LE, van den Wildenberg W, Juttmann JR, Diekerhof CH, de Waal Malefijt J. Prospective clinical follow-up after percutaneous vertebroplasty in patients with painful osteoporotic vertebral compression fractures.J Vasc Interv Radiol2006;17(8):1313–1320.PubMedCrossRefGoogle Scholar
  37. 37.
    Kallmes DF, Jensen ME. Percutaneous vertebroplasty.Radiology2003;229(1):27–36.PubMedCrossRefGoogle Scholar
  38. 38.
    Teng MM, Wei CJ, Wei LC, Luo CB, Lirng JF, Chang FC, Liu CL, Chang CY. Kyphosis correction and height restoration effects of percutaneous vertebroplasty. AJNR Am J Neuroradiol2003;24(9):1893–1900.PubMedGoogle Scholar
  39. 39.
    Hiwatashi A, Moritani T, Numaguchi Y, Westesson PL. Increase in vertebral body height after vertebroplasty.AJNR Am J Neuroradiol2003;24(2):185–189.PubMedGoogle Scholar
  40. 40.
    Bedbrook GM. Treatment of thoracolumbar dislocation and fractures with paraplegia.Clin Orthop Relat Res1975;112:27–43.PubMedGoogle Scholar
  41. 41.
    Kim YS, Kim KW, Park HC, Chung SS, Lee KC. Postural reduction for the compression fracture of the thoracolumbar spines.J Korean Neurosurg Soc 1988;17(6):1421–1431. (Korean)Google Scholar
  42. 42.
    Krompinger WJ, Fredrickson BE, Mino DE, Yuan HA. Conservative treatment of fractures of the thoracic and lumbar spine.Orthop Clin North Am1986;17(1):161–170.PubMedGoogle Scholar
  43. 43.
    Youn SH, Kim KS, Zhang HY, Kim YS. Postural reduction in compression fracture of spines.J Korean Neurosurg Soc1996;25(7):1473–1479. (Korean)Google Scholar
  44. 44.
    McKiernan F, Faciszewski T, Jensen R. Latent mobility of osteoporotic vertebral compression fractures.J Vasc Interv Radiol2006;17(9):1479–1487.PubMedCrossRefGoogle Scholar
  45. 45.
    Bedbrook GM. Stability of spinal fractures and fracture dislocations.Paraplegia 1971;9(1):23–32.PubMedGoogle Scholar
  46. 46.
    Carlier RY, Gordji H, Mompoint DM, Vernhet M, Feydy A, Vallée C. Osteoporotic vertebral collapse: percutaneous vertebroplasty and local kyphosis correction. Radiology2004;233(3):891–898. Epub 2004 Oct 14.PubMedCrossRefGoogle Scholar
  47. 47.
    Mirovsky Y, Anekstein Y, Shalmon E, PeerA. Vacuum clefts of the vertebral bodies.AJNR Am J Neuroradiol2005;26(7):1634–1640.PubMedGoogle Scholar
  48. 48.
    Chin DK, Kim YS, Cho YE, Shin JJ. Efficacy of postural reduction in oste-oporotic vertebral compression fractures followed by percutaneous vertebroplasty. Neurosurgery2006;58(4):695–700.PubMedCrossRefGoogle Scholar
  49. 49.
    Hulme PA, Krebs J, Ferguson SJ, Berlemann U. Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies.Spine2006;31(17):1983–2001.PubMedCrossRefGoogle Scholar
  50. 50.
    Phillips FM, Ho E, Campbell-Hupp M, McNally T, Todd Wetzel F, Gupta P. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures.Spine2003;28(19):2260–2265; discussion 2265–2267.PubMedCrossRefGoogle Scholar
  51. 51.
    Berlemann U, Franz T, Orler R, Heini PF. Kyphoplasty for treatment of oste-oporotic vertebral fractures: a prospective non-randomized study Eur Spine J2004;13(6):496–501.PubMedCrossRefGoogle Scholar
  52. 52.
    Kasperk C, Hillmeier J, Noldge G, Grafe IA, Dafonseca K, Raupp D, Bardenheuer H, Libicher M, Liegibel UM, Sommer U, Hilscher U, Pyerin W, Vetter M, Meinzer HP, Meeder PJ, Taylor RS, NawrothP. Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study. J Bone Miner Res 2005;20(4):604–612. Epub 2005 Apr 5.PubMedCrossRefGoogle Scholar
  53. 53.
    Pflugmacher R, Kandziora F, Schröder R, Schleicher P, Scholz M, Schnake K, Haas N, Khodadadyan-Klostermann C. [Vertebroplasty and kyphoplasty in osteoporotic fractures of vertebral bodies — a prospective 1-year follow-up analysis].Rofo 2005;177(12):1670–1676. (Ger)PubMedGoogle Scholar
  54. 54.
    Pflugmacher R, Schleicher P, Schröder RJ, Melcher I, Klostermann CK. Maintained pain reduction in five patients with multiple myeloma 12 months after treatment of the involved cervical vertebrae with vertebroplasty.Acta Radiol2006;47(8):823–829.PubMedCrossRefGoogle Scholar
  55. 55.
    Lin EP, Ekholm S, Hiwatashi A, Westesson PL. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body.AJNR Am J Neuroradiol2004;25(2):175–180.PubMedGoogle Scholar
  56. 56.
    Chen YJ, Tan TS, Chen WH, Chen CC, Lee TS. Intradural cement leakage: a devastatingly rare complication of vertebroplasty. Spine2006;31(12):E379–E382.PubMedCrossRefGoogle Scholar
  57. 57.
    Chiras J, Depriester C, Weill A, Sola-Martinez MT, Déramond H. [Percutaneous vertebral surgery. Technics and indications.]J Neuroradiol1997;24:45–59. (Fr)PubMedGoogle Scholar
  58. 58.
    Yeom JS, Kim WJ, Choy WS, Lee CK, Chang BS, Kang JW. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg Br 2003;85(1):83–89.PubMedCrossRefGoogle Scholar
  59. 59.
    MacTaggart JN, Pipinos II, Johanning JM, Lynch TG. Acrylic cement pulmonary embolus masquerading as an embolized central venous catheter fragment. J Vasc Surg 2006;43(1):180–183.PubMedCrossRefGoogle Scholar
  60. 60.
    Scroop R,Eskridge J, Britz GW. Paradoxical cerebral arterial embolization of cement during intraoperative vertebroplasty: case report. AJNR Am J Neuroradiol 2002;23(5):868–870.PubMedGoogle Scholar
  61. 61.
    Cotten A, Boutry N, Cortet B, Assaker R, Demondion X, Leblond D, Chastanet P, Duquesnoy B, Déramond H. Percutaneous vertebroplasty: state of the art. Radiographics 1998;18(2):311–320; discussion320–323.PubMedGoogle Scholar
  62. 62.
    Laredo JD, Hamze B. Complications of percutaneous vertebroplasty and their prevention. Semin Ultrasound CT MR 2005;26(2):65–80.PubMedCrossRefGoogle Scholar
  63. 63.
    Choe DH, Marom EM, Ahrar K, Truong MT, Madewell JE. Pulmonary embolism of polymethyl methacrylate during percutaneous vertebroplasty and kyphoplasty. AJR Am J Roentgenol 2004;183(4):1097–1102.PubMedGoogle Scholar
  64. 64.
    Padovani B, Kasriel O, Brunner P, Peretti-Viton P. Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. AJNR Am J Neuroradiol 1999;20(3):375–377.PubMedGoogle Scholar
  65. 65.
    Tozzi P, Abdelmoumene Y, Corno AF, Gersbach PA, Hoogewoud HM, von SegesserL K. Management of pulmonary embolism during acrylic vertebroplasty. Ann Thorac Surg 2002;74(5):1706–1708.PubMedCrossRefGoogle Scholar
  66. 66.
    Baroud G, Vant C, Wilcox R. Long-term effects of vertebroplasty: adjacent vertebral fractures. J Long Term Eff Med Implants 2006;16(4):265–280.PubMedGoogle Scholar
  67. 67.
    Ananthakrishnan D, Lotz JC, Berven S, Puttlitz C. Changes in spinal loading due to vertebral augmentation: vertebroplasty versus kyphoplasty. In: Annual Meeting of the American Academy of Orthopaedic Surgeons. 2003. p.472(New Orleans).Google Scholar
  68. 68.
    Grados F, Depriester C, Cayrolle G, Hardy N, Déramond H, Fardellone P. Long-term observations of vertebral osteoporotic fractures treated by percutaneous verte-broplasty. Rheumatology (Oxford) 2000;39:1410–1414.CrossRefGoogle Scholar
  69. 69.
    Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 2003;226(1):119–124.PubMedCrossRefGoogle Scholar
  70. 70.
    Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol 2006;27(1):217–223.PubMedGoogle Scholar
  71. 71.
    Eyheremendy EP, De Luca SE, Sanabria E. Percutaneous pediculoplasty in oste-oporotic compression fractures. J Vasc Interv Radiol 2004;15(8):869–874.PubMedGoogle Scholar
  72. 72.
    Trout AT, Kallmes DF, Lane JI, Layton KF, Marx WF. Subsequent vertebral fractures after vertebroplasty: association with intraosseus clefts. AJNR Am J Neuroradiol 2006;27(7):1586–1591.PubMedGoogle Scholar
  73. 73.
    Trout AT, Kallmes DF. Does vertebroplasty cause incident vertebral fractures? A review of available data. AJNR Am J Neuroradiol 2006;27(7):1397–1403.PubMedGoogle Scholar
  74. 74.
    Vats HS, McKiernan FE. Infected vertebroplasty: case report and review of literature. Spine 2006;31(22):E859–E862.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Sandra Narayanan
    • 1
  • Frank C. Tong
    • 1
  1. 1.Emory University HospitalAtlantaUSA

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