Minimally Invasive Reduction and Internal Stabilization of Osteoporotic Vertebral Body Fractures (Balloon Kyphoplasty)

Abstract

Objective:

Restoration of height of a fractured vertebral body with an inflatable balloon system introduced transpedicularly into the vertebral body. The system creates a cavity that is filled with bone cement. This minimally invasive procedure creates an internal stabilization.

Indications:

Osteoporotic vertebral compression fractures with an intact posterior wall. Osteolytic metastases. Primary benign vertebral tumors such as hemangiomata. Traumatic compression fractures with an intact posterior wall.

Contraindications:

Unstable burst fractures involving the posterior wall. Coagulopathies. Disk herniation accompanied by radiculopathy. Compression of entire vertebral body (vertebra plana).

Surgical Technique:

In prone position and under fluoroscopic control transpedicular placement of Yamshidi needles into the posterior third of the vertebral body through stab incisions. Insertion of guide wires through these needles for proper placement of working cannulae. Drilling of a channel for insertion of the balloon system. Under fluoroscopy in two planes, pressure- controlled filling of the balloon with a contrast medium. Once the proper vertebral height has been obtained, removal of contrast medium and balloon and filling of the cavity with cement avoiding any leakage into the spinal canal. Once the cement has hardened, removal of working cannulae, skin closure.

Results:

In a prospective study of 95 patients (165 vertebral bodies) with osteoporotic fractures treated with PMMA cement or calcium phosphate filling, we observed a marked symptom reduction in 89%. The average restoration of height amounted to 16%. Cement leakage not leading to any complications occurred in 14 vertebral bodies (8%), a percentage far below published values of 20–70%.