Treating Osteoporotic and Neoplastic Vertebral Compression Fractures with Vertebroplasty and Kyphoplasty

Abstract

Compression fractures are common in patients with osteoporosis and cancer. In particular, vertebral compression fractures are crippling, and pose an additional risk of cord compression. Although a number of nonmedical options such as bracing and exercise programs may help these patients, the combination of constant, severe pain and spinal instability was until recently almost invariably synonymous with painful gradual deterioration and a poor quality of life. Vertebroplasty, and more recently kyphoplasty, are minimally invasive procedures that aim at limiting or reversing painful collapse of the vertebrae, while providing stability to the treated segment of the spine. As these new options are highly effective and involve minimal risk, it is important that physicians be familiar with them. This paper reviews the demographics of vertebral compression fractures, both osteoporotic and neoplastic, the technical aspects of vertebroplasty and kyphoplasty, and current results and outcomes. Pain relief rates in excess of 90% have been reported with both vertebroplasty and kyphoplasty in patients with vertebral compression fractures. Procedural complication rates should be very low, in the 1%-2% range at most with proper technique. Until the advent of vertebroplasty, almost no effective therapeutic option could be offered to patients suffering from neoplastic or osteoporotic vertebral compression fractures, which are relatively common and often crippling. The technical feasibility of these procedures is high, the risk low, and the effectiveness high. Therefore, it is important that physicians consider vertebroplasty and kyphoplasty as viable and strong options.