European Spine Journal

, Volume 12, Supplement 2, pp S163–S167 | Cite as

Interdisciplinary approach to balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures

  • Helmut Franck
  • Bronek M. Boszczyk
  • Michael Bierschneider
  • Hans Jaksche
Review

Abstract

Osteoporotic vertebral compression fractures (VCFs) are associated with a series of clinical consequences leading to increased morbidity and even mortality. Early diagnosis and therapeutic intervention is desirable in order to remobilise patients and prevent further bone loss. Not all fractures are, however, sufficiently treatable by conservative measures. Here, vertebroplasty and kyphoplasty may provide immediate pain relief by minimally invasive fracture stabilisation. In cases of acute fractures, kyphoplasty has the potential to reduce kyphosis and restore the normal sagittal alignment of the spine. The complex nature of systemic osteoporosis, coupled with the intricate biomechanics of vertebral fractures, leads to a clinical setting which is ideally treated interdisciplinarily by the rheumatologist and spine surgeon.

Keywords

Vertebral compression fracture Osteoporosis Kyphoplasty Vertebroplasty 

References

  1. 1.
    Belkoff SM, Mathis JM, Fenton DC, Scribner RM, Reiley ME, Talmadge K (2001) An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture. Spine 26:151–156CrossRefPubMedGoogle Scholar
  2. 2.
    Bernhard J, Heini PF, Villiger PM (2003) Asymptomatic diffuse pulmonary embolism caused by acrylic cement: an unusual complication of percutaneous vertebroplasty. Ann Rheum Dis 62:85–86CrossRefPubMedGoogle Scholar
  3. 3.
    Black DM, Thompson DE (1999) The effect of alendronate therapy on osteoporotic fracture in the vertebral fracture arm of the Fracture Intervention Trial. Int J Clin Pract Suppl 101:46–50PubMedGoogle Scholar
  4. 4.
    Boszczyk B, Bierschneider M, Potulski M, Robert B, Vastmans J, Jaksche H (2002) Erweitertes Anwendungsspektrum der Kyphoplastie zur Stabilisierung der osteoporotischen Wirbelfraktur. Unfallchirurg 105:952–957CrossRefGoogle Scholar
  5. 5.
    Boszczyk BM, Bierschneider M, Robert B, Jaksche H (2003) Treatment of severe osteoporotic fractures through a microsurgical interlaminary approach. In: Szpalski M, Gunzburg R (eds) Vertebral osteoporotic compression fractures. Lippincott WW, Philadelphia, pp 179–188Google Scholar
  6. 6.
    Chen HL, Wong CS, Ho ST, Chang FL, Hsu CH, Wu CT (2002) A lethal pulmonary embolism during percutaneous vertebroplasty. Anesth Analg 95:1060–1062PubMedGoogle Scholar
  7. 7.
    Cooper C, Atkinson EJ, O'Fallon WM, Melton LJ III (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, MN (1985–1989). J Bone Miner Res 7:221–227PubMedGoogle Scholar
  8. 8.
    Davis JW, Grove JS, Wasnich RD, Ross PD (1999) Spatial relationships between prevalent and incident spine fractures. Bone 24:261–264CrossRefPubMedGoogle Scholar
  9. 9.
    Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 282(7):637–645PubMedGoogle Scholar
  10. 10.
    European Commission (1998) Report on osteoporosis in the European Community, action for prevention.Google Scholar
  11. 11.
    Garfin SR, Hansen AY, Reiley MA (2001) Kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 26:1511–1515PubMedGoogle Scholar
  12. 12.
    Garfin SR, Lin G, Lieberman I, Phillips F, Truumees E (2001) Retrospective analysis of the outcomes of balloon kyphoplasty to treat vertebral body compression fracture refractory to medical management (Abstract). Eur Spine J 10: S7–S8Google Scholar
  13. 13.
    Gold DT (1996) The clinical impact of vertebral body fractures: quality of life in women with osteoporosis. Bone 3: S185–S189CrossRefGoogle Scholar
  14. 14.
    Hansson T, Roos B, Naghemson A (1975) Development of osteopenia in the fourth lumbar vertebra during prolonged bed rest after operation for scoliosis. Acta Orthop Scand 46:621–30PubMedGoogle Scholar
  15. 15.
    Harrington KD (2001) Major neurological complications following percutaneous vertebroplasty with polymethylmethacrylate. J Bone Joint Surg 84-A: 1070–1073Google Scholar
  16. 16.
    Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, Chesnut CH 3rd, Brown J, Eriksen EF, Hoseyni MS, Axelrod DW, Miller PD (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282(14):1344–1352PubMedGoogle Scholar
  17. 17.
    Heini PF, Wälchli B, Berlemann U (2000) Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. Eur Spine J 9:445–450PubMedGoogle Scholar
  18. 18.
    Jang JS, Lee SH, Jung SK (2002) Pulmonary embolism of polymethylmethacrylate after percutaneous vertebroplasty. Spine 27: E416–E418PubMedGoogle Scholar
  19. 19.
    Kanis JA, Brazier JE, Stevenson M, Calvert NW, Lloyd Jones M (2002) Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 6(29):1–146Google Scholar
  20. 20.
    Keller TS, Kosmopoulos V, Liebschner MA (2003) Modeling of bone damage and fracture in osteoporosis. In: Szpalski M, Gunzburg R (eds) Vertebral osteoporotic compression fractures. Lippincott WW, Philadelphia, pp 35–50Google Scholar
  21. 21.
    Lee BJ, Lee SR, Yoo TY (2002) Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate. Spine 27: E419–E422CrossRefPubMedGoogle Scholar
  22. 22.
    Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323PubMedGoogle Scholar
  23. 23.
    Lyles KW, Gold DT, Shipp KM, Pieper CF, Martinez S, Mulhausen PL (1993) Association of osteoporotic vertebral body compression fractures with impaired functional status. Am J Med 94:595–601PubMedGoogle Scholar
  24. 24.
    Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201PubMedGoogle Scholar
  25. 25.
    Michel BA, Bloch DA, Wolfe F, Fries JF (1993) Fractures in rheumatoid arthritis: an evaluation of associated risk factors. J Rheumatol 10:1666–1669Google Scholar
  26. 26.
    Padovani B, Kasriel O, Brunner P, Peretti-Viton P (1999) Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. Am J Neuroradiol 20:375–377PubMedGoogle Scholar
  27. 27.
    Ratliff J, Nguyen T, Heiss J (2001) Root and spinal cord compression from methylmethacrylate vertebroplasty. Spine 26:E300–E302CrossRefPubMedGoogle Scholar
  28. 28.
    Riggs BL, Melton LJ III (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 5: S505–S511Google Scholar
  29. 29.
    Ross PD, Genant HK, Davis JW, Miller PD, Wasnich RD (1993) Predicting vertebral fracture incidence from prevalent fractures and bone density among none-black, osteoporotic women. Osteoporosis Int 3:120–126Google Scholar
  30. 30.
    Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Grunze M, Ziegler R, Leidig-Bruckner G (1998) Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporosis Int 8:261–267CrossRefGoogle Scholar
  31. 31.
    Scroop R, Eskridge J, Britz GW (2002) Paradoxical cerebral embolization of cement during intraoperative vertebroplasty: case report. Am J Neuroradiol 23:868–870PubMedGoogle Scholar
  32. 32.
    Silverman SL (1992) The clinical consequences of vertebral compression fractures. Bone 13: S27–S31PubMedGoogle Scholar
  33. 33.
    Tozzi P, Abdelmoumene Y, Corno AF, Gersbach PA, Hoogewoud HM, von Segesser LK (2002) Management of pulmonary embolism during acrylic vertebroplasty. Ann Thorac Surg 74:1706–1708CrossRefPubMedGoogle Scholar
  34. 34.
    Wenger W, Markwalder TM (1999) Surgically controlled, transpedicular methyl methacrylate vertebroplasty with flouroscopic guidance. Acta Neurochir 141:625–631CrossRefGoogle Scholar
  35. 35.
    Wilke HJ, Mehnert U, Boszczyk B, Bierschneider M, Jaksche H, Claes LE (2002) Biomechanical evaluation of vertebro- and kyphoplasty under cyclic loading (Abstract). Eur Spine J 11:613CrossRefGoogle Scholar
  36. 36.
    Wilson DR, Myers ER, Mathis JM, Scribner RM, Conta JA, Reiley MA, Talmadge KD, Hayes WC (2002) Effect of augmentation on the mechanics of vertebral wedge fractures. Spine 25:158–165CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Helmut Franck
    • 1
  • Bronek M. Boszczyk
    • 2
  • Michael Bierschneider
    • 2
  • Hans Jaksche
    • 2
  1. 1.Center of RheumatologyOberammergauGermany
  2. 2.Department of NeurosurgeryBerufsgenossenschaftliche Unfallklinik MurnauMurnauGermany

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