Surgical Therapy: Vertebro-Cifoplastic: – Pros and Cons

Abstract

Vertebral compression fractures (VCFs) are the most common complication of osteoporosis. They result in significant mortality and morbidity and prolonged pain for patients. Vertebroplasty (PVP) and kyphoplasty (PKP) have recently been introduced for the treatment of osteoporotic patients who have prolonged pain following VCFs not responding to conservative treatment. Both procedures are based on the injection of a bone cement, usually polymethyl methacrylate (PMMA), into the fractured vertebra for the mechanical stabilization of VCFs and for pain relief. These procedures may be useful for osteoporotic patients who have prolonged pain following acute vertebral fracture and seem to determine a rapid and sustained pain relief with a better quality of life. Short-term complications, mainly the result of leakage extravasation of cement, include increased pain and damage from heat or pressure to the spinal cord or nerve roots as well as embolism problem. Proper patient selection and good technique should minimize complications, but, rarely, open surgery is needed. Long-term benfits have not yet been shown but potentially include prevention of recurrent pain at the treated level(s) with both procedures and with kyphoplasty restoration of height loss and spinal deformity, an improvement in level of function, and avoidance of chronic pain and restriction of internal organs. Controlled trials are needed to determine both short-term and long-term safety and efficacy of vertebroplasty and kyphoplasty.