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
Long Y et al: Advances in vertebral augmentation systems for osteoporotic vertebral compression fractures. Pain Res Manag. 2020:3947368, 2020
Manz D et al: Vertebral augmentation with spinal implants: third-generation vertebroplasty. Neuroradiology. 62(12):1607-15, 2020
Zhang HR et al: Percutaneous vertebral augmentation procedures in the management of spinal metastases. Cancer Lett. 475:136-42, 2020
Bousson V et al: Percutaneous vertebral augmentation techniques in osteoporotic and traumatic fractures. Semin Intervent Radiol. 35(4):309-23, 2018
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
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
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
El-Fiki M: Vertebroplasty, kyphoplasty, lordoplasty, expandable devices, and current treatment of painful osteoporotic vertebral fractures. World Neurosurg. 91:628-32, 2016
Hussain A et al: Vertebroplasty augmentation procedures: examining the controversy. Pain Physician. 16(5):E483-90, 2013
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
Esses SI et al: The treatment of symptomatic osteoporotic spinal compression fractures. J Am Acad Orthop Surg. 19(3):176-82, 2011
Luetmer MT et al: Asymptomatic and unrecognized cement pulmonary embolism commonly occurs with vertebroplasty. AJNR Am J Neuroradiol. 32(4):654-7, 2011
Schiff D et al: Kyphoplasty in cancer: an encouraging step. Lancet Oncol. 12(3):202-3, 2011
Tancioni F et al: Percutaneous vertebral augmentation in metastatic disease: state of the art. J Support Oncol. 9(1):4-10, 2011
Zhang JD et al: Comparison of vertebroplasty and kyphoplasty for complications. Orthop Surg. 3(3):158-60, 2011
Hiwatashi A et al: Ultrashort TE MRI: usefulness after percutaneous vertebroplasty. AJR Am J Roentgenol. 195(5):W365-8, 2010
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
Knavel EM et al: Clinical outcomes with hemivertebral filling during percutaneous vertebroplasty. AJNR Am J Neuroradiol. 30(3):496-9, 2009
Knavel EM et al: Vertebroplasty for the treatment of traumatic nonosteoporotic compression fractures. AJNR Am J Neuroradiol. 30(2):323-7, 2009
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
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
Hiwatashi A et al: Vertebroplasty for osteoporotic fractures with spinal canal compromise. AJNR Am J Neuroradiol. 28(4):690-2, 2007
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
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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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
Long Y et al: Advances in vertebral augmentation systems for osteoporotic vertebral compression fractures. Pain Res Manag. 2020:3947368, 2020
Manz D et al: Vertebral augmentation with spinal implants: third-generation vertebroplasty. Neuroradiology. 62(12):1607-15, 2020
Zhang HR et al: Percutaneous vertebral augmentation procedures in the management of spinal metastases. Cancer Lett. 475:136-42, 2020
Bousson V et al: Percutaneous vertebral augmentation techniques in osteoporotic and traumatic fractures. Semin Intervent Radiol. 35(4):309-23, 2018
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
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
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
El-Fiki M: Vertebroplasty, kyphoplasty, lordoplasty, expandable devices, and current treatment of painful osteoporotic vertebral fractures. World Neurosurg. 91:628-32, 2016
Hussain A et al: Vertebroplasty augmentation procedures: examining the controversy. Pain Physician. 16(5):E483-90, 2013
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
Esses SI et al: The treatment of symptomatic osteoporotic spinal compression fractures. J Am Acad Orthop Surg. 19(3):176-82, 2011
Luetmer MT et al: Asymptomatic and unrecognized cement pulmonary embolism commonly occurs with vertebroplasty. AJNR Am J Neuroradiol. 32(4):654-7, 2011
Schiff D et al: Kyphoplasty in cancer: an encouraging step. Lancet Oncol. 12(3):202-3, 2011
Tancioni F et al: Percutaneous vertebral augmentation in metastatic disease: state of the art. J Support Oncol. 9(1):4-10, 2011
Zhang JD et al: Comparison of vertebroplasty and kyphoplasty for complications. Orthop Surg. 3(3):158-60, 2011
Hiwatashi A et al: Ultrashort TE MRI: usefulness after percutaneous vertebroplasty. AJR Am J Roentgenol. 195(5):W365-8, 2010
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
Knavel EM et al: Clinical outcomes with hemivertebral filling during percutaneous vertebroplasty. AJNR Am J Neuroradiol. 30(3):496-9, 2009
Knavel EM et al: Vertebroplasty for the treatment of traumatic nonosteoporotic compression fractures. AJNR Am J Neuroradiol. 30(2):323-7, 2009
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
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
Hiwatashi A et al: Vertebroplasty for osteoporotic fractures with spinal canal compromise. AJNR Am J Neuroradiol. 28(4):690-2, 2007
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
Pommersheim W et al: Sacroplasty: a treatment for sacral insufficiency fractures. AJNR Am J Neuroradiol. 24(5):1003-7, 2003
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