Abstract
Since the introduction of percutaneous vertebroplasty in the 1980s and the approval of polymethyl methacrylate by the US Food and Drug Administration in 2004, vertebroplasty and kyphoplasty became widespread strategies for managing patients with osteoporotic compression fracture or vertebral body tumor. Although there have been some controversies regarding the clinical efficacy of vertebroplasty or kyphoplasty compared to conservative treatment or sham treatment, these minimally invasive simple procedures are available for pain control and early recovery of daily life and are cost-effective.
It is necessary to set exact indications, learn proper surgical techniques, and pay attention to the complications associated with a favorable prognosis. The most common application of vertebroplasty or kyphoplasty is for osteoporotic compression fractures; however, there is no complete consensus regarding the indications. Surgeons should be aware of the general worldwide indications and contraindications. In addition, it is fundamental to learn the correct surgical techniques, possible complications, and how to deal with them.
In this chapter, we describe not only the detailed surgical techniques including some controversial points but also the general knowledge of vertebroplasty and kyphoplasty.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet (London, England). 2002;359(9321):1929–36.
Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol. 2006;194(Suppl. 2):S3–11.
Lee YL, Yip KM. The osteoporotic spine. Clin Orthop Relat Res. 1996;323:91–7.
Borgström F, Zethraeus N, Johnell O, et al. Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int. 2006;17(5):637–50.
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–33.
Lippuner K, Golder M, Greiner R. Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland. Osteoporos Int. 2005;16(Suppl 2):S8–s17.
Gangi A, Kastler BA, Dietemann JL. Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy. AJNR Am J Neuroradiol. 1994;15(1):83–6.
Deramond H, Depriester C, Toussaint P. Vertebroplasty and percutaneous interventional radiology in bone metastases: techniques, indications, contra-indications. Bull Cancer Radiother. 1996;83(4):277–82.
Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol. 1997;18(10):1897–904.
Son S, Lee SG, Kim WK, Park CW, Yoo CJ. Early Vertebroplasty versus delayed Vertebroplasty for acute osteoporotic compression fracture: are the results of the two surgical strategies the same? J Korean Neurosurg Soc. 2014;56(3):211–7.
Guo JB, Zhu Y, Chen BL, al. Surgical versus non-surgical treatment for vertebral compression fracture with osteopenia: a systematic review and meta-analysis. PLoS One. 2015;10(5):e0127145.
Lou S, Shi X, Zhang X, Lyu H, Li Z, Wang Y. Percutaneous vertebroplasty versus non-operative treatment for osteoporotic vertebral compression fractures: a meta-analysis of randomized controlled trials. Osteoporos Int. 2019;30(12):2369–80.
Balkarli H, Kilic M, Balkarli A, Erdogan M. An evaluation of the functional and radiological results of percutaneous vertebroplasty versus conservative treatment for acute symptomatic osteoporotic spinal fractures. Injury. 2016;47(4):865–71.
Yang EZ, Xu JG, Huang GZ, et al. Percutaneous Vertebroplasty versus conservative treatment in aged patients with acute osteoporotic vertebral compression fractures: a prospective randomized controlled clinical study. Spine. 2016;41(8):653–60.
Voormolen MH, Mali WP, Lohle PN, et al. Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol. 2007;28(3):555–60.
Buchbinder R, Osborne RH, Ebeling PR, et al. Efficacy and safety of vertebroplasty for treatment of painful osteoporotic vertebral fractures: a randomised controlled trial [ACTRN012605000079640]. BMC Musculoskelet Disord. 2008;9:156.
Park HB, Son S, Jung, JM, Lee, SG, Yoo BR. Safety and Efficacy of Bone Cement (Spinofill®) for Vertebroplasty in Patients with Osteoporotic Compression Fracture: A Preliminary Prospective Study. J Korean Neurosrug Soc. 2022;65(5): 730–40.
Buchbinder R, Johnston RV, Rischin KJ, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev. 2018;4(4):Cd006349.
Stevenson M, Gomersall T, Lloyd Jones M, et al. Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral fractures: a systematic review and cost-effectiveness analysis. Health Technol Assess (Winchester, England). 2014;18(17):1–290.
Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361(6):557–68.
Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361(6):569–79.
Klazen CA, Lohle PN, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet (London, England). 2010;376(9746):1085–92.
Lin JH, Chien LN, Tsai WL, Chen LY, Chiang YH, Hsieh YC. Early vertebroplasty associated with a lower risk of mortality and respiratory failure in aged patients with painful vertebral compression fractures: a population-based cohort study in Taiwan. Spine J. 2017;17(9):1310–8.
Láinez Ramos-Bossini AJ, López Zúñiga D, Ruiz SF. Percutaneous vertebroplasty versus conservative treatment and placebo in osteoporotic vertebral fractures: meta-analysis and critical review of the literature. Eur Radiol. 2021;31(11):8542–53.
Sanli I, van Kuijk SMJ, de Bie RA, van Rhijn LW, Willems PC. Percutaneous cement augmentation in the treatment of osteoporotic vertebral fractures (OVFs) in the elderly: a systematic review. Eur Spine J. 2020;29(7):1553–72.
Yuan WH, Hsu HC, Lai KL. Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures: a meta-analysis. Medicine. 2016;95(31):e4491.
Mattie R, Laimi K, Yu S, Saltychev M. Comparing percutaneous Vertebroplasty and conservative therapy for treating osteoporotic compression fractures in the thoracic and lumbar spine: a systematic review and meta-analysis. J Bone Joint Surg Am. 2016;98(12):1041–51.
Pron G, Hwang M, Smith R, Cheung A, Murphy K. Cost-effectiveness studies of vertebral augmentation for osteoporotic vertebral fractures: a systematic review. Spine J. 2022;25(8):923–8.
Barr JD, Barr MS, Lemley TJ, McCann RM. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine (Phila Pa 1976). 2000;25(8):923–8.
Heini PF, Wälchli B, Berlemann U. Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J. 2000;9(5):445–50.
Pérez-Higueras A, Alvarez L, Rossi RE, Quiñones D, Al-Assir I. Percutaneous vertebroplasty: long-term clinical and radiological outcome. Neuroradiology. 2002;44(11):950–4.
Brown DB, Gilula LA, Sehgal M, Shimony JS. Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty. AJR Am J Roentgenol. 2004;182(2):319–22.
Kaufmann TJ, Jensen ME, Schweickert PA, Marx WF, Kallmes DF. Age of fracture and clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2001;22(10):1860–3.
Ensrud KE, Schousboe JT. Clinical practice. Vertebral fractures. N Engl J Med. 2011;364(17):1634–42.
Stadhouder A, Buskens E, Vergroesen DA, Fidler MW, de Nies F, Oner FC. Nonoperative treatment of thoracic and lumbar spine fractures: a prospective randomized study of different treatment options. J Orthop Trauma. 2009;23(8):588–94.
McConnell CT Jr, Wippold FJ 2nd, Ray CE Jr, et al. ACR appropriateness criteria management of vertebral compression fractures. J Am Coll Radiol. 2014;11(8):757–63.
Rodriguez AJ, Fink HA, Mirigian L, et al. Pain, quality of life, and safety outcomes of Kyphoplasty for vertebral compression fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res Off J Am Soc Bone Miner Res. 2017;32(9):1935–44.
Wang H, Sribastav SS, Ye F, et al. Comparison of percutaneous Vertebroplasty and balloon Kyphoplasty for the treatment of single level vertebral compression fractures: a meta-analysis of the literature. Pain Physician. 2015;18(3):209–22.
Gu CN, Brinjikji W, Evans AJ, Murad MH, Kallmes DF. Outcomes of vertebroplasty compared with kyphoplasty: a systematic review and meta-analysis. J Neurointerv Surg. 2016;8(6):636–42.
Huang X, Chang H, Xu H, Chen X, Wang H, Song Y. Comparison of outcomes between percutaneous vertebroplasty and percutaneous kyphoplasty for the treatment of Kümmell’s disease: a meta-analysis. Clinical Spine Surg. 2021;35(6):276–86.
Genev IK, Tobin MK, Zaidi SP, Khan SR, Amirouche FML, Mehta AI. Spinal compression fracture management: a review of current treatment strategies and possible future avenues. Global spine J. 2017;7(1):71–82.
Esses SI, McGuire R, Jenkins J, et al. The treatment of symptomatic osteoporotic spinal compression fractures. J Am Acad Orthop Surg. 2011;19(3):176–82.
Kobayashi N, Numaguchi Y, Fuwa S, et al. Prophylactic vertebroplasty: cement injection into non-fractured vertebral bodies during percutaneous vertebroplasty. Acad Radiol. 2009;16(2):136–43.
Cooper C, Atkinson EJ, O'Fallon WM, Melton LJ 3rd. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989. J Bone Miner Res Off J Am Soc Bone Miner Res. 1992;7(2):221–7.
Silverman SL. The clinical consequences of vertebral compression fracture. Bone. 1992;13(Suppl 2):S27–31.
Diamond T, Clark W, Bird P, Gonski P, Barnes E, Gebski V. Early vertebroplasty within 3 weeks of fracture for acute painful vertebral osteoporotic fractures: subgroup analysis of the VAPOUR trial and review of the literature. Eur Spine J. 2020;29(7):1606–13.
Jemal A, Murray T, Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin. 2005;55(1):10–30.
Boland PJ, Lane JM, Sundaresan N. Metastatic disease of the spine. Clin Orthop Relat Res. 1982;169:95–102.
Brihaye J, Ectors P, Lemort M, Van Houtte P. The management of spinal epidural metastases. Adv Tech Stand Neurosurg. 1988;16:121–76.
Nottebaert M, von Hochstetter AR, Exner GU, Schreiber A. Metastatic carcinoma of the spine. A study of 92 cases. Int Orthop. 1987;11(4):345–8.
Jang JS, Lee SH. Efficacy of percutaneous vertebroplasty combined with radiotherapy in osteolytic metastatic spinal tumors. J Neurosurg Spine. 2005;2(3):243–8.
Health Quality Ontario. Vertebral augmentation involving vertebroplasty or kyphoplasty for cancer-related vertebral compression fractures: a systematic review. Ont Health Technol Assess Ser. 2016;16(11):1–202.
Cardoso ER, Ashamalla H, Weng L, et al. Percutaneous tumor curettage and interstitial delivery of samarium-153 coupled with kyphoplasty for treatment of vertebral metastases. J Neurosurg Spine. 2009;10(4):336–42.
Pilitsis JG, Rengachary SS. The role of vertebroplasty in metastatic spinal disease. Neurosurg Focus. 2001;11(6):e9.
Zhang ZF, Yang JL, Jiang HC, et al. An updated comparison of high- and low-viscosity cement vertebroplasty in the treatment of osteoporotic thoracolumbar vertebral compression fractures: a retrospective cohort study. Int J Surg (London, England). 2017;43:126–30.
Wang H, Zhang T, Cheung KM, Shea GK. Application of deep learning upon spinal radiographs to predict progression in adolescent idiopathic scoliosis at first clinic visit. EClinical Medicine. 2021;42:101220.
Molloy S, Mathis JM, Belkoff SM. The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty. Spine. 2003;28(14):1549–54.
Kaufmann TJ, Trout AT, Kallmes DF. The effects of cement volume on clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2006;27(9):1933–7.
Martinčič D, Brojan M, Kosel F, et al. Minimum cement volume for vertebroplasty. Int Orthop. 2015;39(4):727–33.
Li YA, Lin CL, Chang MC, Liu CL, Chen TH, Lai SC. Subsequent vertebral fracture after vertebroplasty: incidence and analysis of risk factors. Spine. 2012;37(3):179–83.
Molloy S, Riley LH 3rd, Belkoff SM. Effect of cement volume and placement on mechanical-property restoration resulting from vertebroplasty. AJNR Am J Neuroradiol. 2005;26(2):401–4.
Jeon SI, Choe IS, Kwon YS, Seo DH, Lee KC, Park SC. Comparative clinical results of vertebroplasty using jamshidi® needle and bone void filler for acute vertebral compression fractures. Korean J Spine. 2012;9(3):239–43.
Yan L, He B, Guo H, Liu T, Hao D. The prospective self-controlled study of unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty. Osteoporos Int. 2016;27(5):1849–55.
Chang W, Zhang X, Jiao N, et al. Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: a meta-analysis. Medicine. 2017;96(17):e6738.
Yin P, Ji Q, Wang Y, et al. Percutaneous kyphoplasty for osteoporotic vertebral compression fractures via unilateral versus bilateral approach: a meta-analysis. J Clin Neurosci. 2019;59:146–54.
Zhiyong C, Yun T, Hui F, Zhongwei Y, Zhaorui L. Unilateral versus bilateral balloon kyphoplasty for osteoporotic vertebral compression fractures: a systematic review of overlapping meta-analyses. Pain Physician. 2019;22(1):15–28.
Chen Y, Zhang H, Chen H, Ou Z, Fu Y, Zhang J. Comparison of the effectiveness and safety of unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a protocol for systematic review and meta-analysis. Medicine. 2021;100(51):e28453.
Blasco J, Martinez-Ferrer A, Macho J, San Roman L, Pomés J, Carrasco J, et al. Effect of vertebroplasty on pain relief, quality of life, and the incidence of new vertebral fractures: a 12-month randomized follow-up, controlled trial. J Bone Miner Res Off J Am Soc Bone Miner Res. 2012;27(5):1159–66.
Ahn Y, Lee JH, Lee HY, Lee SH, Keem SH. Predictive factors for subsequent vertebral fracture after percutaneous vertebroplasty. J Neurosurg Spine. 2008;9(2):129–36.
Luo J, Annesley-Williams DJ, Adams MA, Dolan P. How are adjacent spinal levels affected by vertebral fracture and by vertebroplasty? A biomechanical study on cadaveric spines. Spine J. 2017;17(6):863–74.
Ma X, Xing D, Ma J, et al. Risk factors for new vertebral compression fractures after percutaneous vertebroplasty: qualitative evidence synthesized from a systematic review. Spine. 2013;38(12):E713–22.
Xie W, Jin D, Wan C, et al. The incidence of new vertebral fractures following vertebral augmentation: a meta-analysis of randomized controlled trials. Medicine. 2015;94(37):e1532.
Klazen CA, Venmans A, de Vries J, et al. Percutaneous vertebroplasty is not a risk factor for new osteoporotic compression fractures: results from VERTOS II. AJNR Am J Neuroradiol. 2010;31(8):1447–50.
Li HM, Zhang RJ, Gao H, Jia CY, et al. New vertebral fractures after osteoporotic vertebral compression fracture between balloon kyphoplasty and nonsurgical treatment PRISMA. Medicine. 2018;97(40):e12666.
Zhang H, Xu C, Zhang T, Gao Z, Zhang T. Does percutaneous vertebroplasty or balloon kyphoplasty for osteoporotic vertebral compression fractures increase the incidence of new vertebral fractures? A Meta-Analysis. Pain Physician. 2017;20(1):E13–e28.
Ryu KS, Park CK, Kim MC, Kang JK. Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Neurosurg. 2002;96(1 Suppl):56–61.
Zhan Y, Jiang J, Liao H, Tan H, Yang K. Risk factors for cement leakage after vertebroplasty or kyphoplasty: a meta-analysis of published evidence. World Neurosurg. 2017;101:633–42.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Son, S. (2023). Vertebroplasty and Kyphoplasty. In: Ahn, Y., Park, JK., Park, CK. (eds) Core Techniques of Minimally Invasive Spine Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-19-9849-2_29
Download citation
DOI: https://doi.org/10.1007/978-981-19-9849-2_29
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-19-9848-5
Online ISBN: 978-981-19-9849-2
eBook Packages: MedicineMedicine (R0)