Percutaneous vertebral augmentation: Vertebroplasty and kyphoplasty

Abstract

Vertebroplasty and balloon kyphoplasty are two percutaneous surgical options for the treatment of osteoporotic vertebral compression fractures (VCF) that have become increasingly utilized since their development in the mid 1980s. These well-described techniques can also address VCF caused by metastatic lesions, multiple myeloma, and hemangiomas. Physicians from several disciplines including neurosurgery, orthopedic surgery, and radiology now perform vertebroplasty and balloon kyphoplasty as a routine part of their practice. The surgical goals of vertebroplasty are to stabilize the fractured vertebral body and provide relief from pain. Pain is thought to be alleviated from bonding and strengthening the fractured vertebral body, as well as from the thermal reaction that occurs during the curing of the polymethylmethacrylate (PMMA) cement. Balloon kyphoplasty has similar goals but also aims at partially correcting the deformity by restoring the vertebral body height. However, controversy does exist over whether the pain is relieved from fracture stabilization, the PMMA thermal reaction, or from the restoration of vertebral height. Recent developments have included using an arc osteotome, which is placed through a percutaneous transpedicular approach, for cavity creation prior to filling the defect with PMMA cement. This chapter summarizes the indications, techniques, and complications for both the vertebroplasty with and without cavity creation.