Vertebroplasty and kyphoplasty for osteoporotic fractures

Pin-Hole surgical treatment for vertebral body compression fracture with Vertebroplasty / Balloon Kyphoplasty:


Vertebral body compression fractures (VCFs)- fractures of weakened vertebral body resulting from trivial trauma/loading during normal daily activities- are extremely common amongst the patients with osteoporosis. Osteoporosis is a systemic skeletal disease characterized by compromised bone strength due to the damage to the normal architecture of the bone. Amongst many causes of the osteroporosis senile osteoporosis ( due to older age) and osteoporosis secondary to menopause ( loss of hormonal support) constitutes largest groups of patients suffering from osteoporosis. These are the patients whom we commonly found in our day to day practice presenting with VCFs. VCFs are also found in patients with any disease that weakens vertebral body as in patients with cancers.
In other words, VCFs are commonly found in older age group ( >60 years). It is much more common in elderly females. Almost 25% of female may suffer from VCFs between 60 to 80 years of age. Risck is doubled to 50% beyond 80 years.
VCFs are also found in young population with unaccustomed loading of spine and presents as acute traumatic compression fracture.
The treatment of VCFs is challenging for a medical professional considering the limited options available, particularly for elderly fragile patients. Medical management of these VCFs consists of bed rest, bracing, anti-osteoporotic bone strengthening medications etc. In elderly patients these non-surgical treatment carries risk of multiple complications, which may be potentially life threatening in some cases, like stroke, lung complications, heart complication, adjacent fractures etc. Over and above it propagates the cascade that further weakens the bone due to disuse osteoporosis and may result into fracture elsewhere in the body. Pain arising from these VCFs can be potentially debilitating and may require surgical intervention to provide a quality life in this age group of patients.
Surgical Management is another challenge in geriatric terminally ill patients as they may not tolerate extensive open surgeries and may succumb to surgically induced trauma to body. So the million dollar question is …
“WHAT SHOULD BE DONE? HOW TO TREAT SUCH PATIENTS?”
Minimally Invasive pin-hole vertebroplasty or kyphoplasty can be an answer to this delicate clinical problem. Both surgical procedures have been shown to improve the acute pain and disability associated with VCFs without increasing morbidity of the patient. Balloon kyphoplasty and vertebroplasty are well accepted treatments for VCFs.
First performed in 1984, Vertebroplasty involves injection of bone cement into fractured vertebral body via pedicle as shown in figure. The procedure is performed through a pin hole approach under local anesthesia. The procedure can be a day care surgical intervention wherein patient can get relief of symptoms soon after procedure and may be mobilized and discharged after a few hours of surgery.
First performed in 1998, Balloon kyphoplasty involves percutaneous cannulation of the fractured vertebral body, inflation of the bone tamp (Balloon) inside the vertebral body , and the placement of the cement in the void created by the tamp. It is also performed under local anesthesia through a pin hole approach and can be a day care procedure.

Bone vertebral body augmentation procedure results in stabilization of the VCFs resulting into symptomatic relief. Balloon kyphoplasty differs from vertebroplasty in that tools used to perform kyphoplasty are specifically designed to achieve correction of fracture-related angular deformity and restoration of the lost body height.

An immediate outcome for a patient is more or less same with either procedure. There are no conclusive eveidence to show a clear superiority of a procedure over another. However, studies have shown that the risk of subsequent fracture of the adjacent or non-adjacent verterbral body is greatly reduced with kyphoplasty. This is because kyphoplasty by correcting the deformity and restoring the height , restores the normal bio-mechanics of human spine. Kyphoplasty also helps to inject higher quantity of cement. Higher the cement inside the vertebral body better the stability.

Role of Vertebroplasty/kyphoplasty in acute traumatic burst-compression fracture:

Patients presenting with stable burst fractures or acute traumatic compression fractures without neurological compromise do not need conventional extensive open surgeries. Largely they are treated non-operatively with bed rest, corsets and medications. Pain or disability arising from these fractures may warrants for a surgical intervention in order to restore a patient’s normal functionality. In such patient vertebroplasty/ Kyophoplasty with or without percutaneous screw stabilization could be a truly non-invasive pin-hole surgery.


Conclusion:
Vertebroplasty and kyphoplasty could be a ready and effective minimally invasive option for patients with Vertebral compression fractures in patients who needs to be cured with least invasive measures to avoid morbidity.