Kyphoplasty and Vertebroplasty: Treatments for Compression Osteoporotic Fractures

Nowdays osteoporotic vertebral fractures are a frequent clinical problem. This incidence is substantially increasing with an increasing life expectancy.

Regardless of the potentially serious consequences, many of these fractures are asympthomatic at the beginning and seem to cause almost insignificant changes like loss of height and a mild stoop. Only 25% to 35% osteoporotic vertebral fractures cause severe problems that manifest itself as acute severe pain causing the patient to be confined to bed rest.

In most patients this acute state can be succesfully treated by special combinations of analgetics, adjustment of their daily activities and wearing orthosis.

However, the treating of patients who fail with conservative therapy presents a challenge. With this group of patients  known methods of surgical treatment do not show favourable results due to high operative risk and technical difficulties in correlation with reduced quality of osteoporotic bones.

In the past 20 years the techniques of nonsurgical treatment and prevention of these types of fractures have been perfected to such an extent that osteoporotic vertebral fractures can be avoided and quickly and safely treated with vertebroplasty and kyphoplasty.

 Vertebroplasty

Vertebroplasty was originally developed in France in 1986. In United States it is used since 1991.while in Croatia there have been only sporadic cases of using this method.

Vertebroplasty is a minimally invasive, non surgical procedure developed for pain reduction and prevention of developing compression fractures.

Vertebroplasty literally means the strenghtning of the vertebral body. Along with pain relief, vertebroplasty is used for strenghtning of vertebra that are extremely osteoporotic but still are not fractured, i.e. the compression fracture still has not occured.

Kyphoplasty

Kyphoplasty is a newer treatment for patients with painful vertebral body compression fractures associated with osteoporosis.

Like vertebroplasty, kyphoplasty is a minimally invasive procedure that can alleviate up to 90% of pain caused by compression osteoporotic fracture. In addition to pain relief, kyphoplasty can also stabilize fractures, restore height of the vertebra and the patient and decrease spinal deformity.

How is kyphoplasty performed?

Kyphoplasty is performed under local or general anesthesia. Using image guidance x-rays, two small incisions are made and a probe is placed into the vertebral space where the fracture is located. A baloon is then inserted thru the probe on each side of the bone.

These baloons are inflated with contrast medium until the desired height is achieved. Contrast is then replaced with PMMA cement ( the same cement used in vertebroplasty) to sustain the restored height of the vertebra. The cement hardens quickly, providing strenght and stability to the vertebra, thus relieving pain.
 
The benefits of vertebroplasty and kyphoplasty

Limitations of the conventional treatments of vertebral fractures have led to the refinement od such procedures for the restauration of the vertebra as vertebroplasty and kyphoplasty.

The potential of these procedures is in enabling prevention and treatment of compression spinal fractures, pain reduction, diminishing the chance of fracture happening and correcting spinal deformities caused by fractures.

Additional benefits of these procedures are:

- Short surgical time
- General or local anesthesia required
- Average hospital stay is a few hours up to one day
- Patients can quicky return to their normal everyday routine
- The strenghtning of the vertebra that might develop a fracture

Both vertebroplasty and kyphoplasty use cement as a material which is injected directly into the vertebral fracture. This stabilizes the fracture and significantly decreases the pain.

Kyphoplasty has an additional advantage in the possibility of restauration of  height of the vertebra to diminish spinal deformity and correct stooped posture. Following both these procedures, most patients can promptly resume their normal everyday activities.

Whereas vertebroplasty and kyphoplasty are encouraging procedures for treating this type of pathological changes, the continuos treatment of osteoporosis is also necessary as osteoporosis is the main disorder that causes compression fracture of the spine and changes on other parts of the bone system.