Advertisement

Vertebroplasty and Kyphoplasty

  • Nicole S. Carter
  • Hong Kuan Kok
  • Julian Maingard
  • Hamed Asadi
  • Vinil Shah
  • Thabele Leslie-Mazwi
  • Joshua A. Hirsch
  • Ronil V. Chandra
Chapter

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.

Keywords

Vertebral augmentation Vertebroplasty Kyphoplasty Vertebral compression fracture Osteoporosis Metastasis Pain 

References

  1. 1.
    Ensrud KE, Schousboe JT. Clinical practice. Vertebral fractures. N Engl J Med. 2011;364(17):1634–42.PubMedGoogle Scholar
  2. 2.
    Durie BG, Kyle RA, Belch A, Bensinger W, Blade J, Boccadoro M, et al. Myeloma management guidelines: a consensus reports from the scientific advisors of the International Myeloma Foundation. Hematol J. 2003;4(1):379–98.PubMedGoogle Scholar
  3. 3.
    Hussein MA, Vrionis FD, Allison R, Berenson J, Berven S, Erdem E, et al. The role of vertebral augmentation in multiple myeloma: International Myeloma Working Group consensus statement. Leukaemia. 2008;22:1479–84.Google Scholar
  4. 4.
    Babayev M, Lachmann E, Nagler W. The controversy surrounding sacral insufficiency fractures: to ambulate or not to ambulate? Am J Phys Med Rehabil. 2000;79:404–9.PubMedGoogle Scholar
  5. 5.
    Dittmer DK, Teasell R. Complications of immobilization and bed rest. Part 1: musculoskeletal and cardiovascular complications. Can Fam Physician. 1993;39:1428–32.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Galibert P, Deramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33:166–8.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Bascoulergue Y, Duquesnel J, Leclercq R, et al. Percutaneous injection of methyl methacrylate in the vertebral body for the treatment of various diseases: percutaneous vertebroplasty [abstract]. Radiology. 1988;169P:372.Google Scholar
  8. 8.
    Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol. 1997;18(10):1897–904.PubMedGoogle Scholar
  9. 9.
    Hochmuth K, Proschek D, Schwarz W, Mach M, Kurth AA, Vogl TJ. Percutaneous vertebroplasty in the therapy of osteoporotic vertebral compression fractures: a critical review. Eur Radiol. 2006;16(5):998–1004.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. Spine. 2001;26(14):1631–7.PubMedGoogle Scholar
  11. 11.
    Bouza C, Lopez T, Magro A, Navalpotro L, Amate JM. Efficacy and safety of balloon kyphoplasty in the therapy of osteoporotic vertebral compression fractures. Eur Radiol. 2006;16:998–1004.Google Scholar
  12. 12.
    Katsanos K, Sabharwal T, Adam A. Percutaneous cementoplasty. Seminars interventional radiology. New York: Thieme-Stratton Inc. 2010; 27(2):137–147.Google Scholar
  13. 13.
    Lieberman IH, Togawa D, Kayanja MM. Vertebroplasty and kyphoplasty: filler materials. Spine J. 2005;5(6):305S–16S.PubMedGoogle Scholar
  14. 14.
    Pomrink GJ, DiCicco MP, Clineff TD, Erbe EM. Evaluation of the reaction kinetics of CORTOSS, a thermoset cortical bone void filler. Biomaterials. 2003;24:1023–31.PubMedGoogle Scholar
  15. 15.
    Wong W, Mathis J. Is intraosseous venography a significant safety measure in performance of vertebroplasty? J Vasc Interv Radiol. 2002;13:137–8.PubMedGoogle Scholar
  16. 16.
    Komemushi A, Tanigawa N, Kariya S, Kojima H, Shomura Y, Sawada S. Radiation exposure to operators during vertebroplasty. J Vasc Interv Radiol. 2005;16:1327–32.PubMedGoogle Scholar
  17. 17.
    Caudana R, Renzi Brivio L, Ventura L, Aitini E, Rozzanigo U, Barai G. CT-guided percutaneous vertebroplasty: personal experience in the treatment of osteoporotic fractures and dorsolumbar metastases. Radiol Med (Torino). 2008;113:114–33.Google Scholar
  18. 18.
    Vogl TJ, Proschek D, Schwarz W, Mack M, Hochmuth K. CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures. Eur Radiol. 2006;16:797–803.PubMedGoogle Scholar
  19. 19.
    Moon E, Tam MDBS, Kikano RM, Karuppasamy K. Prophylactic antibiotic guidelines in modern interventional radiology practice. Semin Intervent Radiol. 2010;27(4):327–37.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Yu SW, Chen WJ, Lin WC, et al. Serious pyogenic spondylitis following vertebroplasty—a case report. Spine. 2004;29:E209–11.PubMedGoogle Scholar
  21. 21.
    Kim AK, Jensen ME, Dion JE, Schweickert PA, Kaufmann TJ, Kallmes DF. Unilateral transpedicular percutaneous vertebroplasty: initial experience. Radiology. 2002;222:737–41.PubMedGoogle Scholar
  22. 22.
    Kaufmann TJ, Trout AT, Kallmes DF. The effects of cement volume on clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2006;27:1933–7.PubMedGoogle Scholar
  23. 23.
    Zhu SY, Zhong ZM, Wu Q, Chen JT. Risk factors for bone cement leakage in percutaneous vertebroplasty: a retrospective study of four hundred and eighty five patients. Int Orthop. 2016;40(6):1206–10.Google Scholar
  24. 24.
    Zhang L, Liu Z, Wang J, Feng X, Yang J, Tao Y. Unipedicular versus bipedicular percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a prospective randomized study. BMC Musculoskelet Disord. 2015;16:145.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Molloy S, Riley LH III, Belkoff SM. Effect of cement volume and placement on mechanical-property restoration resulting from vertebroplasty. AJNR Am J Neuroradiol. 2005;26:401–4.Google Scholar
  26. 26.
    Clark W, Bird P, Gonski P, Diamond TH, Smerdely P, McNeil HP, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2016;388(10052):1408–16.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Dansie DM, Luetmer PH, Lane JI, Thielen KR, Wald JT, Kallmes DF. MRI findings after successful vertebroplasty. AJNR Am J Neuroradiol. 2005;26:1595–600.PubMedGoogle Scholar
  28. 28.
    Chandra RV, Meyers PM, Hirsch JA, Abruzzo T, Eskey CJ, et al. Vertebral augmentation: report of the Standards and Guidelines Committee of the Society of Neurointerventional Surgery. J Neurointerv Surg. 2014;6(1):7–15.PubMedGoogle Scholar
  29. 29.
    O’Brien JP, Sims JT, Evans AJ. Vertebroplasty in patients with severe vertebral compression fractures: a technical report. Neuroradiology. 2000;21:1555–8.Google Scholar
  30. 30.
    Guglielmi G, Andreula C, Muto M, Gilula LA. Percutaneous vertebroplasty: indications, contraindications, technique, and complications. Acta Radiol. 2005;46:256–68.PubMedGoogle Scholar
  31. 31.
    Nussbaum DA, Gailloud P, Murphy K. A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site. J Vasc Interv Radiol. 2004;15:1185–92.PubMedGoogle Scholar
  32. 32.
    Zoarski GH, Snow P, Olan WJ, Stallmeyer MJ, Dick BW, Hebel JR, et al. Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol. 2002;13:139–48.PubMedGoogle Scholar
  33. 33.
    Mathis JM, Barr JD, Belkoff SM, et al. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol. 2001;22:373–81.PubMedGoogle Scholar
  34. 34.
    Deramond H, Wright NT, Belkoff SM. Temperature elevation caused by bone cement polymerization during vertebroplasty. Bone. 1999;25:17S–21S.PubMedGoogle Scholar
  35. 35.
    Voormolen MH, Mali WP, Lohle PNM, Fransen H, Lampmann LEH, Van der Graaf Y, et al. Percutaneous vertebroplasty compared with optimal pain medication treatment. AJNR Am J Neuroradiol. 2007;28:555–60.PubMedGoogle Scholar
  36. 36.
    Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361:557–68.Google Scholar
  37. 37.
    Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt CJ, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361:557–68.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Aebi M. Vertebroplasty: about sense and nonsense of uncontrolled ‘controlled randomized trials’. Eur Spine J. 2009;18:1247–8.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Noonan P. Randomized vertebroplasty trials: bad news or sham news? AJNR Am J Neuroradiol. 2009;30(10):1808–9.PubMedGoogle Scholar
  40. 40.
    Bono CM, Heggeness M, Mick C, Resnick D, Watters WC 3rd. North American Spine Society: newly released vertebroplasty randomized controlled trials – a tale of two trials. Spine J. 2010;10(3):238–40.PubMedGoogle Scholar
  41. 41.
    Comstock BA, Sitlani CM, Jarvik JG, Heagerty PJ, Turner JA, Kallmes DF. Investigational vertebroplasty safety and efficacy trial (INVEST): patient-ported outcomes through 1 year. Radiology. 2013;269(1):224–31.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Manchikanti L, Boswell MV, Kaye AD, Helm IS, Hirsch JA. Therapeutic role of placebo: evolution of a new paradigm in understanding research and clinical practice. Pain Physician. 2017;20(5):363–86.PubMedGoogle Scholar
  43. 43.
    Manchikanti L, Knezevic NN, Boswell MV, Kaye AD, Hirsch JA. Epidural injections for lumbar radiculopathy and spinal stenosis: a comparative clinical review and meta-analysis. Pain Physician. 2016;19(3):365–410.Google Scholar
  44. 44.
    Klazen CA, Lohle PN, De Vries J, Jansen FH, Tielbeek AV, Blonk MC, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010;376:1085–92.PubMedGoogle Scholar
  45. 45.
    Chew C, Craig L, Edwards R, Moss J, O’Dwyer PJ. Safety and efficacy of percutaneous vertebroplasty in malignancy: a systematic review. Clin Radiol. 2011;66(1):63–72.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Pron G, Holubowich C, Kaulback K, Health Quality Ontario. Vertebral augmentation involving vertebroplasty or kyphoplasty for cancer-related vertebral compression fractures: a systematic review. Ont Health Technol Assess Ser. 2016;16(11):1–202.PubMedCentralGoogle Scholar
  47. 47.
    Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet. 2009;373:1016–24.PubMedGoogle Scholar
  48. 48.
    Berenson J, Pflugmacher R, Jarzem P, Zonder J, Schechtman K, Tillman JB, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol. 2011;12:225–35.PubMedGoogle Scholar
  49. 49.
    Dohm M, Black CM, Dacre A, Tillman JB, Fueredi GA. A randomized trial comparing balloon kyphoplasty and vertebroplasty for vertebral compression fractures due to osteoporosis. AJNR Am J Neuroradiol. 2014;35(12):2227–36.PubMedGoogle Scholar
  50. 50.
    Chandra RV, Maingard J, Asadi H, Slater LA, Mazwi TL, Marcia S, et al. Vertebroplasty and kyphoplasty for osteoporotic vertebral fractures: what are the latest data? AJNR Am J Neuroradiol. 2018;39(5):798–806.PubMedGoogle Scholar
  51. 51.
    McGirt MJ, Parker SL, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL. Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine. 2009;9(6):501–8.Google Scholar
  52. 52.
    McGraw JK, Cardella J, Barr JD, Mathis JM, Sanchez O, Schwartaberg MS, et al. Society of Interventional Radiology Standards of Practice Committee quality improvement guidelines for percutaneous vertebroplasty. J Vasc Interv Radiol. 2003;14(1):311–5.Google Scholar
  53. 53.
    Chandra RV, Yoo AJ, Hirsch JA. Vertebral augmentation: update on safety, efficacy, cost-effectiveness and increased survival. Pain Physician. 2013;16(4):309–20.PubMedGoogle Scholar
  54. 54.
    Yazbeck PG, Al Rouhban RB, Slaba SG, Kreichati GE, Kharrat KE. Anterior spinal artery syndrome after percutaneous vertebroplasty. Spine J. 2011;11:e5–8.PubMedGoogle Scholar
  55. 55.
    Ratliff J, Nguyen T, Heiss J. Root and spinal cord compression from methyl methacrylate vertebroplasty. Spine. 2001;26:300–2.Google Scholar
  56. 56.
    Laredo JD, Hamze B. Complications of percutaneous vertebroplasty and their prevention. Skelet Radiol. 2004;33:493–505.Google Scholar
  57. 57.
    Barragan-Campos HM, Vallee JN, Lo D, Cormier E, Jean B, Rose M, et al. Percutaneous vertebroplasty for spinal metastases: complications. Radiology. 2006;238:354–62.PubMedGoogle Scholar
  58. 58.
    Yu SW, Chen WJ, Lin WC, Chen YJ, Tu YK. Serious pyogenic spondylitis following vertebroplasty—a case report. Spine. 2004;29:209–11.Google Scholar
  59. 59.
    Childers JC Jr. Cardiovascular collapse and death during vertebroplasty. Radiology. 2003;228:902–3.PubMedGoogle Scholar
  60. 60.
    Zhang H, Xu C, Zhang T, Gao Z, Zhang T. Does percutaneous vertebroplasty or balloon kyphoplasty for osteoporotic vertebral compression fractures increase the incidence of new vertebral fractures? A meta-analysis. Pain Physician. 2017;20(1):13–28.Google Scholar
  61. 61.
    Anderson PA, Froyshteter AB, Tontz WL Jr. Meta-analysis of vertebral augmentation compared to conservative treatment for osteoporotic spinal fractures. J Bone Miner Res. 2013;28(2):372–82.PubMedGoogle Scholar
  62. 62.
    Shi MM, Cai XZ, Lin T, Wang W, Yan SG. Is there really no benefit of vertebroplasty for osteoporotic vertebral fractures? A meta-analysis. Clin Orthop Relat Res. 2012;470(10):2785–99.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Nicole S. Carter
    • 1
  • Hong Kuan Kok
    • 2
  • Julian Maingard
    • 3
    • 4
  • Hamed Asadi
    • 5
  • Vinil Shah
    • 6
  • Thabele Leslie-Mazwi
    • 7
  • Joshua A. Hirsch
    • 8
  • Ronil V. Chandra
    • 9
  1. 1.Monash Health, Interventional Neuroradiology Unit, Monash ImagingClaytonAustralia
  2. 2.Department of RadiologyNorthern HospitalMelbourneAustralia
  3. 3.Interventional Neuroradiology Service, Department of RadiologyAustin HospitalMelbourneAustralia
  4. 4.Interventional Neuroradiology Unit, Monash Imaging, Monash HealthMelbourneAustralia
  5. 5.Department of RadiologyAustin HealthHeidelbergAustralia
  6. 6.Radiology and Biomedical Imaging, Neuroradiology SectionUniversity of California, San FranciscoSan FranciscoUSA
  7. 7.Departments of Neurosurgery and Neurology, Neuroendovascular Program and Neurocritical CareMassachusetts General HospitalBostonUSA
  8. 8.Department of RadiologyMassachusetts General HospitalBostonUSA
  9. 9.Department of Medicine, Surgery and Imaging, Monash Medical Centre, Diagnostic and Interventional Neuroradiology, Monash Imaging-Monash HealthMonash UniversityClaytonAustralia

Personalised recommendations