Vertebroplasty and kyphoplasty: a comparative review of efficacy and adverse events

Abstract

Vertebroplasty and kyphoplasty have become common surgical techniques for the treatment of vertebral compression fractures. Vertebroplasty involves the percutaneous injection of bone cement into the cancellous bone of a vertebral body with the goals of pain alleviation and preventing further loss of vertebral body height. Kyphoplasty utilizes an inflatable balloon to create a cavity for the cement with the additional potential goals of restoring height and reducing kyphosis. Vertebroplasty and kyphoplasty are effective treatment options for the reduction of pain associated with vertebral body compression fractures. Biomechanical studies demonstrate that kyphoplasty is initially superior for increasing vertebral body height and reducing kyphosis, but these gains are lost with repetitive loading. Complications secondary to extravasation of cement include compression of neural elements and venous embolism. These complications are rare but more common with vertebroplasty. Vertebroplasty and kyphoplasty are both safe and effective procedures for the treatment of vertebral body compression fractures.

Utilization of vertebroplasty and kyphoplasty procedures throughout the United States over a recent decade: an analysis of the Nationwide Inpatient Sample

“…Despite the differing approaches, the goals behind both treatment modalities are similar: alleviation of pain and prevention of further deformity (10,20). The purpose of the current study was to determine the trends in utilization and cost of these vertebral augmentation procedures over the recent decade.…”

“…Following the publication in 2009 of the two RCTs questioning the efficacy of vertebroplasty, a decline in both vertebroplasty and kyphoplasty procedures was observed. Sayari and colleagues demonstrated a 94.5% decrease in vertebral augmentation procedures performed in the Medicare dataset alone (20). Soon after the RCTs in 2009, results of the VERTOS II trial were published in 2010, demonstrating vertebroplasty as more effective than conservative therapy treatment of refractory pain following vertebral osteoporotic fractures (21).…”

Post–Vertebral Augmentation Back Pain: Evaluation and Management

“…Although randomized controlled clinical trials with several years of follow-up are required to compare vertebroplasty, kyphoplasty, and the differences in techniques to provide definitive data for optimal treatment of osteoporotic vertebral compression fractures, our results are consistent with those in the literature that show that there is no significant difference in pain relief regardless of the procedure type and the technique used. [21][22][23][24][25] A limitation inherent in all retrospective studies of this nature is the lack of a control group to compare the above-mentioned interventional techniques (ie, SIJ and facet joint injections, epidural injections, and radio-frequency neurolysis) with a cohort who only had vertebral augmentation. Additionally, many patients could not be effectively evaluated initially for facet or SIJ pain because they had severe dominant vertebrogenic pain.…”

Controversies on Vertebroplasty and Kyphoplasty for Vertebral Compression Fractures

“…23 Also, a follow-up of height loss after VAP demonstrated the loss to be greater in kyphoplasty, due to homogeneous distribution of cement, than in vertebroplasty. 24 Therefore, height recovery differences tend to vanish with time. 24 Specifically in cancer-related fractures, Schroeder et al 25 reviewed the literature regarding the safety and efficacy of both techniques, and found similar results.…”

“…24 Therefore, height recovery differences tend to vanish with time. 24 Specifically in cancer-related fractures, Schroeder et al 25 reviewed the literature regarding the safety and efficacy of both techniques, and found similar results. In a pooled analysis of published case series in patients with multiple myeloma, Khan et al 26 found similar clinical results comparing vertebroplasty and kyphoplasty.…”