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Vertebroplasty and Kyphoplasty
Ross Holwerda, MD; Colin J. McCarthy, MB, BCh, BAO, MRCSI, FFR (RCSI); Brandt C. Wible, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Outcomes

          TERMINOLOGY

          • Definitions

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

          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. Firanescu CE et al: Percutaneous vertebroplasty is no risk factor for new vertebral fractures and protects against further height loss (VERTOS IV). Cardiovasc Intervent Radiol. 42(7):991-1000, 2019
                                    2. Kyriakou C et al: The role of cement augmentation with percutaneous vertebroplasty and balloon kyphoplasty for the treatment of vertebral compression fractures in multiple myeloma: a consensus statement from the International Myeloma Working Group (IMWG). Blood Cancer J. 9(3):27, 2019
                                    3. Sørensen ST et al: Vertebroplasty or kyphoplasty as palliative treatment for cancer-related vertebral compression fractures: a systematic review. Spine J. 19(6):1067-75, 2019
                                    4. Nunley PD et al: Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis. J Pain Res. 11:2943-8, 2018
                                    5. Ong KL et al: Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty "sham" trials? Osteoporos Int. 29(2):375-83, 2018
                                    6. David E et al: Initial single center experience: radiofrequency ablation assisted vertebroplasty and osteoplasty using a bipolar device in the palliation of bone metastases. Ann Palliat Med. 6(2):118-24, 2017
                                    7. Filippiadis DK et al: Percutaneous vertebroplasty and kyphoplasty: current status, new developments and old controversies. Cardiovasc Intervent Radiol. 40(12):1815-23, 2017
                                    8. Gonschorek O et al: Percutaneous vertebral augmentation in fragility fractures-indications and limitations. Eur J Trauma Emerg Surg. 43(1):9-17, 2017
                                    9. Laratta JL et al: Utilization of vertebroplasty and kyphoplasty procedures throughout the United States over a recent decade: an analysis of the Nationwide Inpatient Sample. J Spine Surg. 3(3):364-70, 2017
                                    10. Bagla S et al: Multicenter prospective clinical series evaluating radiofrequency ablation in the treatment of painful spine metastases. Cardiovasc Intervent Radiol. 39(9):1289-97, 2016
                                    11. 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
                                    12. El-Fiki M: Vertebroplasty, kyphoplasty, lordoplasty, expandable devices, and current treatment of painful osteoporotic vertebral fractures. World Neurosurg. 91:628-32, 2016
                                    13. Patel VV et al: Superion(®) InterSpinous Spacer for treatment of moderate degenerative lumbar spinal stenosis: durable three-year results of a randomized controlled trial. J Pain Res. 8:657-62, 2015
                                    14. Hussain A et al: Vertebroplasty augmentation procedures: examining the controversy. Pain Physician. 16(5):E483-90, 2013
                                    15. 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
                                    16. Esses SI et al: The treatment of symptomatic osteoporotic spinal compression fractures. J Am Acad Orthop Surg. 19(3):176-82, 2011
                                    17. Luetmer MT et al: Asymptomatic and unrecognized cement pulmonary embolism commonly occurs with vertebroplasty. AJNR Am J Neuroradiol. 32(4):654-7, 2011
                                    18. Schiff D et al: Kyphoplasty in cancer: an encouraging step. Lancet Oncol. 12(3):202-3, 2011
                                    19. Tancioni F et al: Percutaneous vertebral augmentation in metastatic disease: state of the art. J Support Oncol. 9(1):4-10, 2011
                                    20. Zhang JD et al: Comparison of vertebroplasty and kyphoplasty for complications. Orthop Surg. 3(3):158-60, 2011
                                    21. Hiwatashi A et al: Ultrashort TE MRI: Usefulness after percutaneous vertebroplasty. AJR Am J Roentgenol. 195(5):W365-8, 2010
                                    22. 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
                                    23. Buchbinder R et al: A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 361(6):557-68, 2009
                                    24. Knavel EM et al: Clinical outcomes with hemivertebral filling during percutaneous vertebroplasty. AJNR Am J Neuroradiol. 30(3):496-9, 2009
                                    25. Knavel EM et al: Vertebroplasty for the treatment of traumatic nonosteoporotic compression fractures. AJNR Am J Neuroradiol. 30(2):323-7, 2009
                                    26. 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
                                    27. 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
                                    28. Hiwatashi A et al: Vertebroplasty for osteoporotic fractures with spinal canal compromise. AJNR Am J Neuroradiol. 28(4):690-2, 2007
                                    29. Schulman KL et al: Economic burden of metastatic bone disease in the U.S. Cancer. 109(11):2334-42, 2007
                                    30. 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
                                    31. Goetz MP et al: Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol. 22(2):300-6, 2004
                                    32. 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: Percutaneous vertebral body augmentation with acrylic cement injection
                                                • Main goal: Pain relief for patients who fail conservative treatment
                                                • Stabilize vertebral body height preventing further kyphotic spinal angulation
                                              • Kyphoplasty: Percutaneous vertebral body augmentation using balloon catheter to create space within vertebra prior to acrylic cement injection
                                                • Same advantages as vertebroplasty
                                                  • Potential for height restoration
                                                  • Lower rate of acrylic leakage into adjacent tissues
                                              • Sacroplasty: Percutaneous injection of acrylic cement into one or both sacral ala(e) for relief of pain caused by pathologic or insufficiency fracture

                                            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. Firanescu CE et al: Percutaneous vertebroplasty is no risk factor for new vertebral fractures and protects against further height loss (VERTOS IV). Cardiovasc Intervent Radiol. 42(7):991-1000, 2019
                                                                      2. Kyriakou C et al: The role of cement augmentation with percutaneous vertebroplasty and balloon kyphoplasty for the treatment of vertebral compression fractures in multiple myeloma: a consensus statement from the International Myeloma Working Group (IMWG). Blood Cancer J. 9(3):27, 2019
                                                                      3. Sørensen ST et al: Vertebroplasty or kyphoplasty as palliative treatment for cancer-related vertebral compression fractures: a systematic review. Spine J. 19(6):1067-75, 2019
                                                                      4. Nunley PD et al: Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis. J Pain Res. 11:2943-8, 2018
                                                                      5. Ong KL et al: Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty "sham" trials? Osteoporos Int. 29(2):375-83, 2018
                                                                      6. David E et al: Initial single center experience: radiofrequency ablation assisted vertebroplasty and osteoplasty using a bipolar device in the palliation of bone metastases. Ann Palliat Med. 6(2):118-24, 2017
                                                                      7. Filippiadis DK et al: Percutaneous vertebroplasty and kyphoplasty: current status, new developments and old controversies. Cardiovasc Intervent Radiol. 40(12):1815-23, 2017
                                                                      8. Gonschorek O et al: Percutaneous vertebral augmentation in fragility fractures-indications and limitations. Eur J Trauma Emerg Surg. 43(1):9-17, 2017
                                                                      9. Laratta JL et al: Utilization of vertebroplasty and kyphoplasty procedures throughout the United States over a recent decade: an analysis of the Nationwide Inpatient Sample. J Spine Surg. 3(3):364-70, 2017
                                                                      10. Bagla S et al: Multicenter prospective clinical series evaluating radiofrequency ablation in the treatment of painful spine metastases. Cardiovasc Intervent Radiol. 39(9):1289-97, 2016
                                                                      11. 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
                                                                      12. El-Fiki M: Vertebroplasty, kyphoplasty, lordoplasty, expandable devices, and current treatment of painful osteoporotic vertebral fractures. World Neurosurg. 91:628-32, 2016
                                                                      13. Patel VV et al: Superion(®) InterSpinous Spacer for treatment of moderate degenerative lumbar spinal stenosis: durable three-year results of a randomized controlled trial. J Pain Res. 8:657-62, 2015
                                                                      14. Hussain A et al: Vertebroplasty augmentation procedures: examining the controversy. Pain Physician. 16(5):E483-90, 2013
                                                                      15. 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
                                                                      16. Esses SI et al: The treatment of symptomatic osteoporotic spinal compression fractures. J Am Acad Orthop Surg. 19(3):176-82, 2011
                                                                      17. Luetmer MT et al: Asymptomatic and unrecognized cement pulmonary embolism commonly occurs with vertebroplasty. AJNR Am J Neuroradiol. 32(4):654-7, 2011
                                                                      18. Schiff D et al: Kyphoplasty in cancer: an encouraging step. Lancet Oncol. 12(3):202-3, 2011
                                                                      19. Tancioni F et al: Percutaneous vertebral augmentation in metastatic disease: state of the art. J Support Oncol. 9(1):4-10, 2011
                                                                      20. Zhang JD et al: Comparison of vertebroplasty and kyphoplasty for complications. Orthop Surg. 3(3):158-60, 2011
                                                                      21. Hiwatashi A et al: Ultrashort TE MRI: Usefulness after percutaneous vertebroplasty. AJR Am J Roentgenol. 195(5):W365-8, 2010
                                                                      22. 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
                                                                      23. Buchbinder R et al: A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 361(6):557-68, 2009
                                                                      24. Knavel EM et al: Clinical outcomes with hemivertebral filling during percutaneous vertebroplasty. AJNR Am J Neuroradiol. 30(3):496-9, 2009
                                                                      25. Knavel EM et al: Vertebroplasty for the treatment of traumatic nonosteoporotic compression fractures. AJNR Am J Neuroradiol. 30(2):323-7, 2009
                                                                      26. 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
                                                                      27. 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
                                                                      28. Hiwatashi A et al: Vertebroplasty for osteoporotic fractures with spinal canal compromise. AJNR Am J Neuroradiol. 28(4):690-2, 2007
                                                                      29. Schulman KL et al: Economic burden of metastatic bone disease in the U.S. Cancer. 109(11):2334-42, 2007
                                                                      30. 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
                                                                      31. Goetz MP et al: Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol. 22(2):300-6, 2004
                                                                      32. Pommersheim W et al: Sacroplasty: a treatment for sacral insufficiency fractures. AJNR Am J Neuroradiol. 24(5):1003-7, 2003