Minimally invasive techniques for the treatment of osteoporotic vertebral fractures
ABSTRACT Osteoporotic vertebral compression fractures are a leading cause of disability and morbidity in the elderly. The consequences of these fractures include pain, progressive vertebral collapse with resultant spinal kyphosis, and systemic manifestations. Nonsurgical measures have proved unsuccessful in a portion of this population and for this group, minimally invasive vertebral augmentation can be beneficial. Vertebroplasty is designed to address vertebral fracture pain. It involves percutaneous injection of polymethylmethacrylate (PMMA) directly into a fractured vertebral body with the goals of pain relief and prevention of further collapse of the fractured vertebra. Kyphoplasty is designed to address the kyphotic deformity as well as the fracture pain. It involves the percutaneous insertion of an inflatable bone tamp into a fractured vertebral body. Bone tamp inflation works to elevate the end plates and create a cavity to be filled with PMMA with the goals of pain relief, restoration of vertebral body height, and reduced kyphotic deformity. Optimizing surgical technique can improve outcomes and decrease complication rates, and decrease radiation exposure to the patient and surgical team. Obtaining a biopsy prior to cement injection has proved efficacious and may result in the diagnosis of occult pathology underlying a seemingly routine vertebral fracture. As competence and surgical success are acquired, the indications will continue to expand to encompass more challenging pathologies. Recently, vertebral augmentation during spinal decompression and instrumented fusion for burst fracture with neurologic insult has been reported to be successful.
SourceAvailable from: Jae Hyup Lee[Show abstract] [Hide abstract]
ABSTRACT: The consequences of osteoporotic vertebral compression fractures are pain, progressive vertebral collapse with resultant kyphosis, and systemic manifestations. Minimally invasive stabilization procedures such as vertebroplasty and balloon kyphoplasty have been introduced to treat for refractory pain due to these fractures. Vertebroplasty and kyphoplasty are new alternatives for the treatment of osteoporotic vertebral compression fractures. Both methods stabilize the fractured vertebra with polymethylmethacrylate cement to relieve pain and allow immediate mobilization. Kyphoplasty is an extension of vertebroplasty that uses an inflatable bone tamp to restore the vertebral body height while creating a cavity to be filled with bone cement. A large proportion of subjects had some pain relief both in vertebroplasty and kyphoplasty. Vertebral height restoration was possible using kyphoplasty and for a subset of patients using vertebroplasty. Cement leaks occurred in both groups but, the incidence of cement leakage in kyphoplasty is lower than that of the vertebroplasty. Vertebroplasty and kyphoplasty are safe and effective procedures. Good short-term results have been reported following both vertebroplasty and kyphoplasty for the painful osteoporotic vertebral fractures. Severe complications result from bone cement leakage into the spinal canal or the vascular system have been reported but the incidence was very rare. Both vertebroplasty and kyphoplasty offer therapeutic benefit significantly reducing pain and improving mobility in patients with vertebral fracture without significant differences between groups in term of quality. While early results are promising, more research is needed to better understand the log-term effects of both procedures on the human spine.Journal of the Korean Medical Association 01/2009; 52(4). DOI:10.5124/jkma.2009.52.4.382 · 0.18 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: To compare the clinical outcome and complications of high viscosity and low viscosity poly-methyl methacrylate bone cement PVP for severe OVCFs. From December 2010 to December 2012, 32 patients with severe OVCFs were randomly assigned to either group H using high viscosity cement (n=14) or group L using low viscosity cement (n=18). The clinical outcomes were assessed by the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Short Form-36 General Health Survey (SF-36), kyphosis Cobb's angle, vertebral height, and complications. Significant improvement in the VAS, ODI, SF-36 scores, kyphosis Cobb's angle, and vertebral height were noted in both the groups, and there were no significant differences between the two groups. Cement leakage was seen less in group H. Postoperative assessment using computed tomography identified cement leakage in 5 of 17 (29.4%) vertebrae in group H and in 15 of 22 (68.2%) vertebrae in group L (P=0.025). The PVP using high viscosity bone cement can provide the same clinical outcome and fewer complications compared with PVP using low viscosity bone cement. Copyright © 2014. Published by Elsevier B.V.Clinical Neurology and Neurosurgery 12/2014; 129C:10-16. DOI:10.1016/j.clineuro.2014.11.018 · 1.25 Impact Factor
Seminars in Spine Surgery 06/2010; 22(2):67-72. DOI:10.1053/j.semss.2009.12.005