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Vertebroplasty and kyphoplasty: friends or foes?

Vertebroplastica o cifoplastica: amici o nemici?

  • Musculoskeletal Radiology/Radiologia Muscolo-Scheletrica
  • Published:
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Abstract

Purpose

This paper aims to compare vertebroplasty and kyphoplasty by illustrating the two techniques, analysing the results and discussing the indications in relation to the type of fracture.

Materials and methods

Vertebroplasty was performed on 805 vertebral bodies in 485 patients affected by osteoporosis (310), metastasis (160) and vertebral haemangioma (15). The approach was unipedicular in 365 patients and bipedicular in 120 patients. Biopsies were obtained in patients with no known primary cancer (75). Kyphoplasty was performed in 39 patients with Magerl type A1 and A3 fractures within 3 months from the trauma. A bipedicular approach was used in all cases.

Results

Outcomes were assessed on the basis of the visual analogue scale and the Oswestry Disability Index. In patients treated with vertebroplasty, success rates at 24–72 h were 90% for osteoporotic fractures, 100% for vertebral haemangiomas and 77% for metastatic fractures. Extravertebral vascular or discal leakage of cement occurred in 39 patients, but only two of them reported radicular pain due to epidural involvement. Osteoporotic patients developed new vertebral fractures at adjacent levels in 25 cases and at distal levels in 19 cases. In patients treated with kyphoplasty, pain relief was achieved within one month after treatment in 90% of cases. None of the patients wore orthotic braces after treatment, and no vertebral collapse was observed.

Conclusions

Vertebroplasty and kyphoplasty are both useful in the management of vertebral pain. In light of our experience, vertebroplasty is better indicated for vertebral fractures due to osteoporosis, haemangioma or metastasis on account of its simplicity and minimal invasiveness. Kyphoplasty is suggested in acute traumatic fractures of type A1 and A3 according to Magerl, as it allows recovery of vertebral stability and a better distribution of the cement.

Riassunto

Obiettivo

Confrontare le due metodiche, vertebroplastica (VP) e cifoplastica (KP), illustrando la tecnica, discutendo le indicazioni e analizzando i risultati.

Materiali e metodi

Quattrocentottantacinque pazienti sono stati sottoposti a VP, per un totale di 805 metameri: 310 trattati per osteoporosi, 160 per metastasi vertebrali, 15 per angioma. È stato eseguito un approccio monopeduncolare in 365 pazienti, bi-peduncolare in 120 pazienti. La biopsia è stata eseguita nei casi di lesioni dubbie (75 pazienti), senza lesione primitiva nota. Trentanove pazienti, affetti da frattura vertebrale traumatica tipo A1 e A3 secondo Magerl, sono stati sottoposti a KP entro 3 mesi dal trauma. In tali casi è stato eseguito sempre un approccio transpeduncolare bilaterale.

Risultati

I risultati sono stati valutati sulla base del metodo VAS e ODS. Nei pazienti sottoposti a VP, nel giro di 24–72 h, abbiamo riscontrato un successo della procedura nel 90% dei crolli porotici, nel 100% di quelli angiomatosici e nel 77% di quelli neoplastici. Le fughe di cemento extravertebrali vascolari o discali sono state riscontrate in 39 pazienti e solo in 2 casi con comparsa di una sintomatologia clinica radicolare per diffusione epidurale. Nei pazienti porotici, abbiamo riscontrato fratture di vertebre adiacenti in 25 pazienti e nuove fratture di vertebre a distanza da quella già trattata in 19 pazienti. Nei pazienti sottoposti a KP la scomparsa del dolore è avvenuto entro un mese dalla procedure nel 90% dei casi. Nessun paziente ha indossato una ortesi posttrattamento. In nessun caso abbiamo osservato un cedimento strutturale della vertebra trattata.

Conclusioni

Entrambe le metodiche sono valide nel “management” delle sindromi antalgiche vertebrali. Secondo la nostra esperienza e i nostri risultati, riteniamo che, a fronte delle differenze tecniche ed economiche delle due metodiche, il ricorso alla VP nei crolli porotici, angiomatosici aggressivi e neoplastici, è più indicato per la rapida esecuzione e minore invasività. La KP, invece, è preferibile nelle fratture vertebrali recenti tipo Magerl A1 e A3, per la caratteristica di “ripristino” della statica vertebrale e per una migliore distribuzione del cemento nel metamero fratturato.

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Muto, M., Perrotta, V., Guarnieri, G. et al. Vertebroplasty and kyphoplasty: friends or foes?. Radiol med 113, 1171–1184 (2008). https://doi.org/10.1007/s11547-008-0301-6

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  • DOI: https://doi.org/10.1007/s11547-008-0301-6

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