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Vertebral Augmentation and Sacroplasty
Brandt C. Wible, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Outcomes

          TERMINOLOGY

          • Definitions

            • Vertebroplasty (VP): Percutaneous vertebral augmentation (VA) with acrylic cement injection
              • Main goal: Pain relief for patients who fail conservative treatment
              • Stabilize vertebral body height preventing further kyphotic spinal angulation
            • Kyphoplasty (KP): Percutaneous VA using balloon catheter to create space within vertebra prior to acrylic cement injection
              • Same advantages as VP
                • Potential for height restoration
                • Lower rate of acrylic leakage into adjacent tissues
            • Sacroplasty: Percutaneous injection of acrylic cement into 1 or both sacral ala(e) for relief of pain caused by pathologic or insufficiency fracture
          • Osteoporotic Vertebral Compression Fracture

            • 1 in 4 osteoporotic women suffer vertebral compression fracture (VCF), men to lesser degree
            • Thoracolumbar region dominant
            • ~ 2/3 VCF asymptomatic, 1/3 disabling resulting in prolonged bed rest
            • Pain duration several weeks to many months
            • Kyphosis is risk factor new VCF and altered quality of life
            • Osteoporotic VCF associated with excessive mortality

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Procedure Steps

                      • Findings and Reporting

                        • Alternative Procedures/Therapies

                          POST PROCEDURE

                          • Things to Do

                            • Things to Avoid

                              OUTCOMES

                              • Problems

                                • Complications

                                  • Expected Outcomes

                                    Selected References

                                    1. Long Y et al: Advances in vertebral augmentation systems for osteoporotic vertebral compression fractures. Pain Res Manag. 2020:3947368, 2020
                                    2. Manz D et al: Vertebral augmentation with spinal implants: third-generation vertebroplasty. Neuroradiology. 62(12):1607-15, 2020
                                    3. Zhang HR et al: Percutaneous vertebral augmentation procedures in the management of spinal metastases. Cancer Lett. 475:136-42, 2020
                                    4. Bousson V et al: Percutaneous vertebral augmentation techniques in osteoporotic and traumatic fractures. Semin Intervent Radiol. 35(4):309-23, 2018
                                    5. Chandra RV et al: Vertebroplasty and kyphoplasty for osteoporotic vertebral fractures: what are the latest data? AJNR Am J Neuroradiol. 39(5):798-806, 2018
                                    6. Luo W et al: Efficacy of vertebral augmentation for vertebral compression fractures: a review of meta-analyses. Spine Surg Relat Res. 2(3):163-8, 2018
                                    7. Clark W et al: Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 388(10052):1408-16, 2016
                                    8. El-Fiki M: Vertebroplasty, kyphoplasty, lordoplasty, expandable devices, and current treatment of painful osteoporotic vertebral fractures. World Neurosurg. 91:628-32, 2016
                                    9. Hussain A et al: Vertebroplasty augmentation procedures: examining the controversy. Pain Physician. 16(5):E483-90, 2013
                                    10. Otten LA et al: Comparison of balloon kyphoplasty with the new Kiva® VCF system for the treatment of vertebral compression fractures. Pain Physician. 16(5):E505-12, 2013
                                    11. Esses SI et al: The treatment of symptomatic osteoporotic spinal compression fractures. J Am Acad Orthop Surg. 19(3):176-82, 2011
                                    12. Luetmer MT et al: Asymptomatic and unrecognized cement pulmonary embolism commonly occurs with vertebroplasty. AJNR Am J Neuroradiol. 32(4):654-7, 2011
                                    13. Schiff D et al: Kyphoplasty in cancer: an encouraging step. Lancet Oncol. 12(3):202-3, 2011
                                    14. Tancioni F et al: Percutaneous vertebral augmentation in metastatic disease: state of the art. J Support Oncol. 9(1):4-10, 2011
                                    15. Zhang JD et al: Comparison of vertebroplasty and kyphoplasty for complications. Orthop Surg. 3(3):158-60, 2011
                                    16. Hiwatashi A et al: Ultrashort TE MRI: usefulness after percutaneous vertebroplasty. AJR Am J Roentgenol. 195(5):W365-8, 2010
                                    17. Klazen CA et al: Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 376(9746):1085-92, 2010
                                    18. Knavel EM et al: Clinical outcomes with hemivertebral filling during percutaneous vertebroplasty. AJNR Am J Neuroradiol. 30(3):496-9, 2009
                                    19. Knavel EM et al: Vertebroplasty for the treatment of traumatic nonosteoporotic compression fractures. AJNR Am J Neuroradiol. 30(2):323-7, 2009
                                    20. Wardlaw D et al: Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet. 373(9668):1016-24, 2009
                                    21. Gerszten PC et al: Combined percutaneous transpedicular tumor debulking and kyphoplasty for pathological compression fractures. Technical note. J Neurosurg Spine. 6(1):92-5, 2007
                                    22. Hiwatashi A et al: Vertebroplasty for osteoporotic fractures with spinal canal compromise. AJNR Am J Neuroradiol. 28(4):690-2, 2007
                                    23. Strub WM et al: Sacroplasty by CT and fluoroscopic guidance: is the procedure right for your patient? AJNR Am J Neuroradiol. 28(1):38-41, 2007
                                    24. Pommersheim W et al: Sacroplasty: a treatment for sacral insufficiency fractures. AJNR Am J Neuroradiol. 24(5):1003-7, 2003
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Preprocedure

                                        • Procedure

                                          • Outcomes

                                            TERMINOLOGY

                                            • Definitions

                                              • Vertebroplasty (VP): Percutaneous vertebral augmentation (VA) with acrylic cement injection
                                                • Main goal: Pain relief for patients who fail conservative treatment
                                                • Stabilize vertebral body height preventing further kyphotic spinal angulation
                                              • Kyphoplasty (KP): Percutaneous VA using balloon catheter to create space within vertebra prior to acrylic cement injection
                                                • Same advantages as VP
                                                  • Potential for height restoration
                                                  • Lower rate of acrylic leakage into adjacent tissues
                                              • Sacroplasty: Percutaneous injection of acrylic cement into 1 or both sacral ala(e) for relief of pain caused by pathologic or insufficiency fracture
                                            • Osteoporotic Vertebral Compression Fracture

                                              • 1 in 4 osteoporotic women suffer vertebral compression fracture (VCF), men to lesser degree
                                              • Thoracolumbar region dominant
                                              • ~ 2/3 VCF asymptomatic, 1/3 disabling resulting in prolonged bed rest
                                              • Pain duration several weeks to many months
                                              • Kyphosis is risk factor new VCF and altered quality of life
                                              • Osteoporotic VCF associated with excessive mortality

                                            PREPROCEDURE

                                            • Indications

                                              • Contraindications

                                                • Preprocedure Imaging

                                                  • Getting Started

                                                    PROCEDURE

                                                    • Patient Position/Location

                                                      • Procedure Steps

                                                        • Findings and Reporting

                                                          • Alternative Procedures/Therapies

                                                            POST PROCEDURE

                                                            • Things to Do

                                                              • Things to Avoid

                                                                OUTCOMES

                                                                • Problems

                                                                  • Complications

                                                                    • Expected Outcomes

                                                                      Selected References

                                                                      1. Long Y et al: Advances in vertebral augmentation systems for osteoporotic vertebral compression fractures. Pain Res Manag. 2020:3947368, 2020
                                                                      2. Manz D et al: Vertebral augmentation with spinal implants: third-generation vertebroplasty. Neuroradiology. 62(12):1607-15, 2020
                                                                      3. Zhang HR et al: Percutaneous vertebral augmentation procedures in the management of spinal metastases. Cancer Lett. 475:136-42, 2020
                                                                      4. Bousson V et al: Percutaneous vertebral augmentation techniques in osteoporotic and traumatic fractures. Semin Intervent Radiol. 35(4):309-23, 2018
                                                                      5. Chandra RV et al: Vertebroplasty and kyphoplasty for osteoporotic vertebral fractures: what are the latest data? AJNR Am J Neuroradiol. 39(5):798-806, 2018
                                                                      6. Luo W et al: Efficacy of vertebral augmentation for vertebral compression fractures: a review of meta-analyses. Spine Surg Relat Res. 2(3):163-8, 2018
                                                                      7. Clark W et al: Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 388(10052):1408-16, 2016
                                                                      8. El-Fiki M: Vertebroplasty, kyphoplasty, lordoplasty, expandable devices, and current treatment of painful osteoporotic vertebral fractures. World Neurosurg. 91:628-32, 2016
                                                                      9. Hussain A et al: Vertebroplasty augmentation procedures: examining the controversy. Pain Physician. 16(5):E483-90, 2013
                                                                      10. Otten LA et al: Comparison of balloon kyphoplasty with the new Kiva® VCF system for the treatment of vertebral compression fractures. Pain Physician. 16(5):E505-12, 2013
                                                                      11. Esses SI et al: The treatment of symptomatic osteoporotic spinal compression fractures. J Am Acad Orthop Surg. 19(3):176-82, 2011
                                                                      12. Luetmer MT et al: Asymptomatic and unrecognized cement pulmonary embolism commonly occurs with vertebroplasty. AJNR Am J Neuroradiol. 32(4):654-7, 2011
                                                                      13. Schiff D et al: Kyphoplasty in cancer: an encouraging step. Lancet Oncol. 12(3):202-3, 2011
                                                                      14. Tancioni F et al: Percutaneous vertebral augmentation in metastatic disease: state of the art. J Support Oncol. 9(1):4-10, 2011
                                                                      15. Zhang JD et al: Comparison of vertebroplasty and kyphoplasty for complications. Orthop Surg. 3(3):158-60, 2011
                                                                      16. Hiwatashi A et al: Ultrashort TE MRI: usefulness after percutaneous vertebroplasty. AJR Am J Roentgenol. 195(5):W365-8, 2010
                                                                      17. Klazen CA et al: Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 376(9746):1085-92, 2010
                                                                      18. Knavel EM et al: Clinical outcomes with hemivertebral filling during percutaneous vertebroplasty. AJNR Am J Neuroradiol. 30(3):496-9, 2009
                                                                      19. Knavel EM et al: Vertebroplasty for the treatment of traumatic nonosteoporotic compression fractures. AJNR Am J Neuroradiol. 30(2):323-7, 2009
                                                                      20. Wardlaw D et al: Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet. 373(9668):1016-24, 2009
                                                                      21. Gerszten PC et al: Combined percutaneous transpedicular tumor debulking and kyphoplasty for pathological compression fractures. Technical note. J Neurosurg Spine. 6(1):92-5, 2007
                                                                      22. Hiwatashi A et al: Vertebroplasty for osteoporotic fractures with spinal canal compromise. AJNR Am J Neuroradiol. 28(4):690-2, 2007
                                                                      23. Strub WM et al: Sacroplasty by CT and fluoroscopic guidance: is the procedure right for your patient? AJNR Am J Neuroradiol. 28(1):38-41, 2007
                                                                      24. Pommersheim W et al: Sacroplasty: a treatment for sacral insufficiency fractures. AJNR Am J Neuroradiol. 24(5):1003-7, 2003