Kyphoplasty and Vertebroplasty for
Osteoporotic Thoracolumbar Spine Fractures
Osteoporotic vertebral fractures are a major concern, affecting over 100 million people worldwide. These fractures can cause pain and a deformity in the spine called kyphosis.
Kyphosis can negatively impact lung function, bowel movements, and overall quality of life, leading to a decrease in life expectancy. Recent data shows that these spinal deformities can also increase mortality rates.
Non-operative methods of treatment have been inconsistent, leading to the development of surgical methods like vertebroplasty and kyphoplasty. Vertebroplasty involves injecting cement into the fractured vertebra to relieve pain, while kyphoplasty uses balloon tamps to decrease the risk of leakage and correct the deformity.
When performing vertebroplasty, patients are put under general anesthesia and positioned face down with rolls of sheets under the thorax and hips to cause lordosis.
- Trocars are then inserted through the pedicles of the lumbar spine or between the ribs and transverse processes of the thoracic spine.
- Cement is then injected into the anterior vertebral body under fluoroscopic guidance. The injection is stopped when cement fills the area sufficiently or when it starts leaking outside the vertebral body.
Kyphoplasty, like vertebroplasty, is done under general anesthesia with patients lying face down. No particular position for the supports was specified.
- Trocars are inserted through the pedicles at the lumbar spine and between the ribs and transverse processes at the thoracic spine.
- A Kyphoplasty device and introducer system are then used to place two balloons within the vertebral body, which are then filled with saline containing injectable contrast material. Balloon filling and fracture reduction are monitored by lateral fluoroscopy.
- After balloon removal, the cavity is filled with cement to stabilize the reduction.
Before cement injection, a manual check of viscosity is performed in both techniques, which takes place four minutes after the mixing process starts. The quantity of cement employed is documented. If feasible without discomfort, patients can sit up early and begin ambulation on the first day. No braces are required.
Literature has shown various data to assess the effectiveness of a procedure for treating vertebral fractures. Baseline data included pain intensity, time to management, and deformity in the sagittal plane. Perioperative data such as volume of cement injected and hospital stay is also recorded. After the procedure, patients undergo physical evaluations and radiographs to measure wedge and kyphosis angles, as well as cement filling and leakage.
Patients are seen again 3 months later for further evaluation and to compute reductions in wedge and kyphosis angles. Loss of reduction is also calculated by comparing postoperative measurements with those taken at 3 months. These measurements help assess the success of the procedure.
Follow-up is shorter in the vertebroplasty group than in the kyphoplasty group, and more patients are lost to follow-up in the vertebroplasty group. Literature hasn’t found any significant differences in pain intensity, satisfactory filling, cement leakage rate, or hospital stay length between the two groups. However, operative time is twice as long in the kyphoplasty group, and the volume injected was greater.
Both vertebroplasty and kyphoplasty show significant postoperative improvements in wedge angle (WA), but the kyphoplasty group showed a greater improvement. Additionally, there were no instances of systemic complications related to the cement used in the procedures, no neurological complications, and no new fractures in the treated or adjacent vertebrae.
Although the literature shows significant variability, the results confirm that kyphoplasty effectively relieves pain and reduces deformities caused by osteoporotic vertebral fractures. Vertebroplasty, on the other hand, remains a useful option when performed early, as it is faster and less expensive.
There is no difference in the incidence of clinically detectable complications, and cement diffusion into the cancellous bone is better with vertebroplasty than with kyphoplasty. Additionally, Magerl A1 fractures are more challenging to reduce with both techniques, even in patients with osteoporosis.
If you are interested in knowing more about Kyphoplasty and Vertebroplasty for Osteoporotic Thoracolumbar Spine Fractures you have come to the right place!
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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