Vertebroplasty and Kyphoplasty

By Dr Arun Pal Singh

Vertebroplasty is a medical spinal procedure where the fractured vertebra is approached percutaneously [After making a small hole in the skin] and then injecting cement into the fractured vertebra. The procedure was introduced to relieve the pain of osteoporotic fractures.

Initial studies suggested that vertebroplasty provided effective relief of pain but the studies that followed could not achieve the initially published results. Two major studies have recently found that vertebroplasty had no detectable benefit when compared with sham procedures.

Vertebroplasty is also used as palliative treatment in painful spinal tumors and vertebral hemangioma to provide pain relief.

Procedure

Vertebroplasty is a minimally invasive procedure and it is performed under local anesthesia.

During the procedure, bone cement is injected with a biopsy needle into the collapsed or fractured vertebra through a needle under x-ray guidance. The acrylic cement quickly dries and forms a support structure within the vertebra that provides stabilization and strength.

Procedure time varies from 30-120 minutes.

Contraindications

Absolute

Asymptomatic fracture
Active osteomyelitis of the target vertebra
Uncorrectable coagulopathy
Allergy to vertebroplasty cement or opacifying agent

Relative

Significant central canal narrowing from retropulsion
Active systemic infection
Myelopathy or radiculopathy from fracture level

Complications

As such the procedure is quite safe in properly selected patients. The procedure is quite safe. Complications are more common with malignant spinal tumor and vertebral hemangioma than with osteoporotic lesions.

Complications include

Neurologic deficit
Injury to rib, vertebra
Infection
Allergic reaction
Pulmonary embolus
Hemorrhage
Pneumothorax or hemothorax

Baloon Kyphoplasty

Balloon kyphoplasty evolved as the next step in the treatment of vertebral compression fractures after vertebroplasty. The procedure like vertebroplasty aims at restoration of the height of the vertebra.

The procedure is performed through small instruments that are inserted into the vertebral body through the pedicle of the vertebra.

In this procedure, a small balloon is inserted through the entry point and is inflated to restore the height of a collapsed vertebral body and create a cavity inside. The balloon is deflated and withdrawn, and the remaining cavity is filled under low pressure with the cement. This process stabilizes the vertebra internally and facilitates pain relief and restores function.<!–more–>

The procedure has been used in patients who fail to respond to medical management.
Complications

Following are potential complications associated with this procedure

Extrusion of the cement into the spinal canal, resulting in neurological compromise,
Infection
Hematoma
Pulmonary embolus
Failure to relieve pain
Incomplete deformity correction

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About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

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