Vertebroplasty (VP) and kyphoplasty (KP) refer to the percutaneous injection of polymethylmethacrylate (bone cement) into the fractured vertebral body. Percutaneous here refers to penetrating the spine by making tiny incisions in the skin through which only needles and thin tubes can penetrate. The most common applications are osteoporotic fractures of the spine.
Vertebroplasty and kyphoplasty can be used in combination with open surgical techniques for compression fractures of the spine and for osteoporotic fractures. It can be used in tumor-related compression fractures of the spine or in compression fractures that do not heal after trauma and cause severe pain in patients. This treatment can be performed under both local and general anesthesia.
Osteoporosis
Osteoporosis is a decrease in bone density due to the decrease in bone mineral density with age. Osteoporotic compression fractures are fractures due to the highly fragile structure of the spine and are very common in the elderly. Spinal fractures in osteoporotic patients are often seen following very mild trauma such as hard sitting. These fractures can cause severe back and lower back pain and limit physical activity. These compression fractures may progress over time and cause new fractures in neighboring vertebrae with axial loading.
Technique
In vertebroplasty, bone cement is injected directly into the spine, whereas in kyphoplasty, a balloon is first inflated inside the fractured vertebra and the spine is allowed to expand again. The cement is then injected. This way, the bone height is restored and the possibility of the cement getting into the blood vessels or spinal canal is reduced.
Risks
Although this procedure is generally considered a low-risk surgery, some complications can occur. Bleeding, infection and neurological damage due to nerve injury can occur. Rarely, the cement may leak into the spinal canal. This is a more common complication of vertebroplasty. Sometimes there are no clinical symptoms, but sometimes it can cause severe spinal cord and nerve compression. In this case, open surgery may be necessary. Very rarely, cement may leak into the veins and the lungs (pulmonary embolism).
Decision
Acute compression fractures can sometimes be very painful and can completely prevent the elderly patient from moving. Studies around the world have shown that this technique quickly relieves pain and allows the elderly patient to mobilize quickly. In this way, the quality of life of the patients has improved and they have been able to relieve themselves of the important painkillers they were using for pain. In summary, vertebroplasty and kyphoplasty is an effective treatment for acute compression fractures that do not respond to medical treatment. Before deciding to use this method, a risk/benefit analysis should be performed for each individual patient, taking into account possible complications.
