Vertebroplasty and kyphoplasty

Vertebroplasty and its balloon-assisted variant, Kyphoplasty, are imaging-guided procedures that involve percutaneous injection of surgical polymethylmethacrylate (PMMA) cement into a diseased vertebral body. Vertebroplasty provides pain relief and strengthens the bone of vertebrae weakened by disease ¹. Kyphoplasty proponents argue that balloon inflation within the vertebral body prior to cement injection reduces rates of cement leakage and offers the potential for vertebral height restoration, which may improve lifestyle-limiting kyphosis ².

Indications

It can be used as a treatment or as a palliative measure for:

• insufficiency fracture

• aggressive hemangioma

• vertebral multiple myeloma

• vertebral metastases

Contraindications

Absolute contraindications

• septicemia ³

• active infection (osteomyelitis, discitis, cellulitis, etc.) of the vertebra or paravertebral tissues

• uncorrectable coagulopathy

• allergy to bone cement or opacifying agent

Relative contraindications

• chronic fractures (variable relief and therefore not often covered by insurance payers in the US.)

• radiculopathy beyond local vertebral pain, caused by a compressive syndrome unrelated to vertebral collapse ³

  • occasionally, preoperative vertebroplasty can be performed before a spinal decompressive procedure

• retropulsion of a fracture fragment or epidural tumor extension causing signs and symptoms of neurological compromise

• current systemic infection

• patient improving on medical therapy

• prophylaxis in osteoporotic patients

• myelopathy or cauda equina syndrome originating at the fracture level

Complications

• leakage of vertebroplasty

  • compression of adjacent structures

  • inferior vena cava syndrome ⁴

  • note that kyphoplasty has shown lower rates of cement leakage ²

• cement intravasation

  • cement pulmonary embolism: via intravasation into paravertebral veins or IVC

• neurologic injury

  • nerve root traversal

  • spinal cord injury (unlikely in lumbar levels)

• fracture

  • iatrogenic

  • higher rates of adjacent level fracture post-procedure

• bleeding

  • IVC or aorta injury if anterior vertebral cortex is traversed

  • epidural hematoma

  • paravertebral

  • intercostal

• pneumothorax