vertebroplasty

Vertebroplasty

Vertebroplasty and kyphoplasty are similar medical spinal procedures in which bone cement is injected through a small hole in the skin (percutaneously) into a fractured vertebra with the goal of relieving back pain caused by vertebral compression fractures.

see Vertebroplasty Trials.

Osteoporotic vertebral fractures

see Vertebroplasty for osteoporotic vertebral fracture.

Kyphosis prevention

It has been observed that fractured vertebral bodies filled in with cement might also influence the increase of their height and thus lead to reduction of post-traumatic spine kyphosis.

24 patients underwent percutaneous vertebroplasty on account of compression fracture of 40 vertebral bodies in thoracic and lumbar regions. On digital x-ray spine images taken in patients before and after surgery the angle of kyphosis or lordosis of bodies above and below the fractured vertebra was measured with the use of the Cobb method. Vertebroplasty in the material examined caused reduction of kyphosis in 33 cases (80.48%) and correction by 5.78° on average. No regularity was found either between the occurrence of correction (and its level) and operated spine region or between the possibility of kyphosis correction and time that passed between fracture and surgery 1).

The transpedicular approach in percutaneous vertebroplasty (PVP) is a well-established approach for the treatment of vertebral compression fractures (VCFs). However, the value of simple transpedicular biopsy in VCFs is less addressed.

Typically injected through a transpedicular approach.

Previous biomechanical studies were primarily focused on the transpedicular approach.

Extrapedicular approach has been recently developed to provide more symmetric cement filling and has good clinical results. However, no biomechanical data are available to compare these 2 techniques.

Twenty-four osteoporotic vertebral bodies were randomly divided into 2 groups for either transpedicular or extrapedicular vertebroplasty. Six lumbar and 6 thoracic vertebrae were used for each group. Each vertebral body was compressed by 25% of its original height and its strength and stiffness were measured. The vertebral bodies were treated with polymethylmethacrylate using either transpedicular or extrapedicular approach. The height restoration was measured before the treated vertebrae were recompressed to determine posttreatment strength and stiffness. RESULTS: Both techniques increased vertebral strength by approximately 50% of the intact strength. There was no statistical difference in posttreatment strength between these 2 techniques. However, the transpedicular technique had higher stiffness recovery (70% to 80%) from the intact stiffness than the extrapedicular technique (60%). The extrapedicular approach achieved greater height restoration in thoracic vertebrae.

Both extrapedicular and transpedicular techniques increased strength but reduced stiffness compared with the intact condition. The extrapedicular technique achieved greater height restoration possibly attributed to its easier access to the fracture site. These biomechanical data provide useful information when selecting an approach for cement injection in vertebroplasty procedures 2).

Polymethylmethacrylate

see polymethylmethacrylate

see Vertebroplasty complications.

Vertebroplasty for medically refractory vertebral compression fractures (VCF) may offer sustained improvement in pain and function. The procedure is associated with low morbidity and mortality 3).

In a multicenter study, Kallmes et al., randomly assigned 131 patients who had one to three painful osteoporotic vertebral compression fractures to undergo either vertebroplasty or a simulated procedure without cement (control group). The primary outcomes were scores on the modified Roland Morris Disability Questionnaire (RDQ) (on a scale of 0 to 23, with higher scores indicating greater disability) and patients' ratings of average pain intensity during the preceding 24 hours at 1 month (on a scale of 0 to 10, with higher scores indicating more severe pain). Patients were allowed to cross over to the other study group after 1 month.

All patients underwent the assigned intervention (68 vertebroplasties and 63 simulated procedures). The baseline characteristics were similar in the two groups. At 1 month, there was no significant difference between the vertebroplasty group and the control group in either the RDQ score (difference, 0.7; 95% confidence interval [CI], -1.3 to 2.8; P=0.49) or the pain rating (difference, 0.7; 95% CI, -0.3 to 1.7; P=0.19). Both groups had immediate improvement in disability and pain scores after the intervention. Although the two groups did not differ significantly on any secondary outcome measure at 1 month, there was a trend toward a higher rate of clinically meaningful improvement in pain (a 30% decrease from baseline) in the vertebroplasty group (64% vs. 48%, P=0.06). At 3 months, there was a higher crossover rate in the control group than in the vertebroplasty group (51% vs. 13%, P<0.001) [corrected]. There was one serious adverse event in each group.

Improvements in pain and pain-related disability associated with osteoporotic compression fractures in patients treated with vertebroplasty were similar to the improvements in a control group 4).


1)
Dragan SF, Urbański W, Żywirski B, Krawczyk A, Kulej M, Dragan SŁ. Kyphosis correction after vertebroplasty in osteoporotic vertebral compression fractures. Acta Bioeng Biomech. 2012;14(4):63-9. PubMed PMID: 23394347.
2)
Erkan S, Wu C, Mehbod AA, Cho W, Transfeldt EE. Biomechanical comparison of transpedicular versus extrapedicular vertebroplasty using polymethylmethacrylate. J Spinal Disord Tech. 2010 May;23(3):180-5. doi: 10.1097/BSD.0b013e31819c48a4. PubMed PMID: 20065863.
3)
Mukherjee S, Yeh J, Ellamushi H. Pain and functional outcomes following vertebroplasty for vertebral compression fractures - A tertiary centre experience. Br J Neurosurg. 2015 Oct 20:1-7. [Epub ahead of print] PubMed PMID: 26485360.
4)
Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009 Aug 6;361(6):569-79. doi: 10.1056/NEJMoa0900563. Erratum in: N Engl J Med. 2012 Mar 8;366(10):970. PubMed PMID: 19657122; PubMed Central PMCID: PMC2930487.
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