Abstract
Osteoporotic-associated vertebral compression fractures are a major public health concern, dwarfing even hip fractures in incidence in the United States. These fractures carry a significant morbidity and mortality burden and also represent a major growing source of consumption of scarce heath resources. Percutaneous vertebroplasty remains a commonly used and safe technique for the symptomatic treatment of vertebral compression fractures, both osteoporotic- and neoplastic-induced. By carefully selecting appropriate patients who are referred promptly, vertebroplasty can provide significant and durable pain relief over traditional conservative therapy. Recent controversies surrounding the evidence for vertebroplasty in osteoporotic-associated vertebral compression fractures are reviewed. A comprehensive step-by-step practical guide to performing vertebroplasty is then described. A brief description of patient selection, workup, as well as complications is also provided.
Highlights
Two related interventional procedures are performed for the treatment of painful vertebral compression fractures (VCF), percutaneous vertebroplasty (PV), and kyphoplasty
Conclusions on Available Evidence for PV. It can be concluded from the available literature that long-term effectiveness and complication data from PV is currently lacking
Despite the seemingly conflicting available data, it is the authors’ opinion that there is some evidence available that in the acute to subacute period, in those who are failing conservative treatment or at are at increased risk from immobilisation, PV can provide good pain relief compared with conservative treatment, though as yet no durable long-term benefit has been demonstrated
Summary
Two related interventional procedures are performed for the treatment of painful vertebral compression fractures (VCF), percutaneous vertebroplasty (PV), and kyphoplasty. Both involve the fluoroscopically or CT-guided percutaneous placement of wide-bored cannulae into the fractured vertebral body which is subsequently cemented with synthetic bone cement, typically polymethylmethacrylate (PMMA). The incidence of VCF in the US alone is estimated to be 750,000 [4], a figure that makes VCF more common than osteoporotic-related hip fractures. The majority of these vertebral fractures are secondary to osteoporosis. PV offers a less invasive therapeutic option for generally elderly patients with multiple comorbidities which allows for early immobilisation
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