Injecting Cement into the Spine with Vertebroplasty and Kyphoplasty
A look at the role of vertebroplasty and kyphoplasty on osteoporosis
Osteoporosis happens when bones become thin, fragile, and weak — so much so that a fall or a coughing spell can cause a break or a fracture. Since bone is living tissue, it's constantly breaking down and replacing itself. When a person has osteoporosis, the development of new bone can't keep up with this regenerative process. This causes fragility in the bone resulting in osteoporosis. This condition is most commonly diagnosed in people over 50 and is most common in white and Asian women with the highest risk being women who are post-menopause. Osteoporosis can be extremely painful, cause disability, and strike the bones in the spine. Two possible treatment options, vertebroplasty and kyphoplasty, both of which treat osteoporosis by injecting cement into the bones, have been effective in helping relieve the pain caused by this condition. Let's look at what these treatments are and how they work.
What is Vertebroplasty?
Vertebroplasty is a surgical procedure in which a fractured vertebra is treated by injecting a special cement into the spine. The goal of vertebroplasty is to restore spinal mobility and relieve pain. Vertebroplasty is a smooth procedure with a 1 percent to 3 percent complication rate. In some patients, vertebroplasty may worsen the pain as the bone cement sets into the spine, but those cases are rare and pain may only last a few hours.
While generally well tolerated. Risks may include:
- Rib or nearby bone fractures
- Irritation at the nerve roots
- Cement escaping the bone before it solidifies
If you have concerns about pain or possible risk, talk to your doctor who can answer your questions about this procedure.
How It Works
What is Kyphoplasty?
Kyphoplasty, similar to vertebroplasty, is intended to help restore a more natural shape to the vertebral body while also helping it heal faster. While vertebroplasty cements it in place, it does not restore the normal shape to the vertebral body. A doctor may recommend kyphoplasty if cases of osteoporosis leave the patient hunched over from a vertebra that has compressed or collapsed.
Like vertebroplasty, kyphoplasty is a low-risk procedure. However, as with any surgery, patients can have adverse reactions to the procedure. The risks of kyphoplasty include:
- Increased back pain
- Nerve damage causing tingling, numbness or weakness
- Allergic reactions to chemicals used with X-rays that assist the surgeon with the injection
- Cement leaking out of place
Depending on your condition, there may be other associated risks. Be sure to talk to your doctor about any concerns you may have and potential risks you should consider before choosing the procedure.
How It Works
History and Candidacy
Doctors performed the first vertebroplasty in France in 1987. The procedure drew international interest as it continued to grow and develop first in Europe and then in the United States. The procedure yielded 60-90 percent success rates in creating pain relief. Vertebroplasty was also used to secure pedicle screws and fill tumorous voids before being used for spinal procedures.
For those who wonder if they are candidates for vertebroplasty or kyphoplasty, the criteria is simple: men and women with compression fractures. Vertebroplasty and kyphoplasty are recommended after conservative treatments fail. Most patients who require these treatments are elderly (70 years or older) and have osteoporosis. Some patients with other vertebral conditions are candidates, but not all people with vertebral fractures qualify.
Benefits & Risks
A study published with The National Center for Biotechnology Information found vertebroplasty to be "an effective and safe procedure for treating vertebral compression fractures in the elderly." The researchers said the procedure provides "immediate pain relief and allows early mobilization, thus avoiding potentially severe complications related to persistent back pain and prolonged bed rest." They concluded by stating that complication rate is low when an experienced surgeon performs the procedure which makes it safe with satisfactory outcomes.
While some medical professionals support the procedure, others approach it with caution.
Jeffrey M. Spivak, M.D., director of the Hospital for Joint Diseases Spine Center in New York, NY, noted in the clinical journal American Family Physician that while "there has been increasing interest in vertebroplasty and kyphoplasty for the management of acute vertebral fractures” neither technique has been extensively tested to weigh the benefits over traditional medical management that surgeons should perform these procedures on select patients.
The long-term benefits of the procedures have rarely been noted, says Olivier Lamy, a doctor in the bone unit of Lausanne University Hospital (Switzerland) Doctors. He recommends vertebroplasty or kyphoplasty should "involve the patients to whom VP/KP is being proposed in the decision-making process.” According to Lamy, more studies to identify the correct patient profile for the procedures are necessary.
A study highlighting the long-term outcomes of vertebroplasty for osteoporotic compression fractures concluded that vertebroplasty "provides significant and clinically meaningful reductions in pain, analgesic use, and disability in the short, medium and long term." Patients using the procedure over conservative therapies had "greater functional improvement." In summation, the procedure is safe with no risk of new fracture.
As for kyphoplasty, a study on three-year outcomes in patients with osteoporosis with painful fractures reported a reduction in pain and improved mobility in patients with osteoporosis.
If you have a vertebral compression fracture your physician can help you decide which, if either, of these procedures may be right for you.