Controversial Issues in Kyphoplasty and Vertebroplasty in Osteoporotic Vertebral Fractures

Abstract

Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed for many years for the treatment of osteoporotic vertebral fractures. The purpose of this review is to resolve the controversial issues raised by the two randomized trials that claimed no difference between VP and SHAM procedure. In particular we compare nonsurgical management (NSM) and KP and VP, in terms of clinical parameters (pain, disability, quality of life, and new fractures), cost-effectiveness, radiological variables (kyphosis correction and vertebral height restoration), and VP versus KP for cement extravasation and complications profile. Cement types and optimal filling are analyzed and technological innovations are presented. Finally unipedicular/bipedicular techniques are compared. Conclusion. VP and KP are superior to NSM in clinical and radiological parameters and probably more cost-effective. KP is superior to VP in sagittal balance improvement and cement leaking. Complications are rare but serious adverse events have been described, so caution should be exerted. Unilateral procedures should be pursued whenever feasible. Upcoming randomized trials (CEEP, OSTEO-6, STIC-2, and VERTOS IV) will provide the missing link.

Kyphoplasty and Vertebroplasty in the Treatment of Osteoporotic Vertebral Fractures

“…[10][11][12] Even though conservative treatment continues to be the gold standard in many centers, 8,13 several studies have reported that vertebral augmentation procedures have shown to be an effective treatment, and even superior to conservative treatment in some studies. 6,15,16 In this study, we observed a significant improvement in the patients who were submitted to vertebral augmentation procedures, both in terms of their functionality (ODI) and pain (VAS), which coincides with other similar studies that have been conducted. 6,13,16 It is important to note that there is still controversy around the superiority of either of the vertebral augmentation procedures (kyphoplasty or vertebroplasty).…”

“…8,15 It is for these patients that vertebral augmentation procedures have appeared as an useful alternative in the treatment of OVFs. 6,8,15,16 Among vertebral augmentation procedures, two have shown to be more effective: vertebroplasty and balloon kyphoplasty ( Figure 1). 6,8,16 Vertebroplasty was first described for the treatment of aggressive vertebral hemangiomas of the lumbar spine.…”

“…6,8,15,16 Among vertebral augmentation procedures, two have shown to be more effective: vertebroplasty and balloon kyphoplasty ( Figure 1). 6,8,16 Vertebroplasty was first described for the treatment of aggressive vertebral hemangiomas of the lumbar spine. 17 Bone cement is injected into the vertebra via a transpedicular approach, which helps to stabilize the vertebral fracture, improving both strength and stability.…”

“…8 Vertebroplasty and kyphoplasty have been shown to be effective in improving both pain and the quality of life of patients with OVF, even when compared to conservative treatment. 6,15,16 However, there is still controversy around whether any of these treatments is more effective or safer in terms of the incidence of complications. 6,13,15,16,18 Another controversy revolves around comparing the effectiveness of and complications resulting from the use of one versus two portals.…”

“…6,13,15,16,18 Another controversy revolves around comparing the effectiveness of and complications resulting from the use of one versus two portals. 5,6,16,19 For this reason, the objective of this study is to compare the results obtained and the incidence of complications from these two procedures in patients treated in our facility.…”