Vertébroplastie, cyphoplastie

Abstract

Vertebroplasty consists in injecting an acrylic cement into a weakened vertebra in order to consolidate it and to reduce pain due to vertebral fracture. Among the many vertebroplasties performed each year, osteoporotic vertebral fractures are the main indication. However, the data in the literature on its actual effectiveness are discussed, particularly for studies that compare this technique to a sham procedure. The reasons for these discrepancies are related to the differences between the studies for several parameters: the intensity of the initial pain, the time elapsed since the diagnosis of vertebral fracture and the characteristics of the population taken into account in these studies. However, when the indications are properly stated, the effectiveness appears undeniable. Two situations seem to be privileged: on the one hand, elderly subjects hospitalized for a particularly painful vertebral fracture. These elderly people are particularly vulnerable and the severity of vertebral fractures in this population in terms of morbidity but also mortality is well known. The second situation concerns younger subjects whose pain persists despite well-managed medical treatment. Kyphoplasty consists first of all in placing a balloon in the weakened vertebrae, then removing it and finally injecting the acrylic cement into the cavity thus created. The theoretical advantage over vertebroplasty is the possibility of some degree of vertebral height restoration when the fracture is recent which is associated with a moderate decrease in angular kyphosis. Carry out in expert centres, severe complications secondary to these two techniques are rare. The most frequent are cement leaks outside the vertebral body, which seem less frequent after kyphoplasty than after vertebroplasty. In the vast majority of cases, these are asymptomatic. The neurological complications inherent in cement leaks have now fortunately become very exceptional. Finally, in the most recent studies, the increased risk of vertebral fracture adjacent to the treated vertebra does not seem to be confirmed.