Differences in Vertebroplasty and Kyphoplasty Procedures

03 Nov Differences in Vertebroplasty and Kyphoplasty Procedures

Vertebroplasty and kyphoplasty are two similar minimally invasive procedures that treat spinal vertebral compression fractures (VCFs). These wedge-shaped, painful fractures are caused by osteoporosis or injury to the spine. If left untreated, VCF can cause kyphosis (humped spine). Find out how these two procedures differ in the treatment of vertebral compression fractures.

While both vertebroplasty and kyphoplasty are similar procedures, the differ in that vertebroplasty involves injection of bone cement through a hollow needle into the fractured bone, whereas kyphoplasty utilizes a balloon device that inflates and expands the compressed vertebra before the cement is instilled. The procedures involve use of bone cement to improve the vertebra structure, reduce pain, and prevent further fracture. The benefit of kyphoplasty over vertebroplasty is that the vertebra is returned to normal position before the bone hardens.

What causes a vertebra compression fracture?

When the body of a vertebra (spine bone) collapses into itself, more in the front than the back, it produces a wedged vertebra. When several vertebrae become wedge-shaped, people can develop a humped spine, which cause pain and loss of mobility. Vertebral compression fractures occur in people with weakened bones, which is caused mainly from osteoporosis (depletion of calcium), but can occur due to multiple myeloma (bone marrow cancer).

Because the bones are already soft and weak, simple activities may cause fractures, such as lifting an object, coughing, or sneezing. VCFs cause loss of mobility, problems sleeping, depression, and back pain. Clinical studies show that people who have one osteoporotic fracture are 5 times more likely to suffer additional fractures.

Who is a candidate for kyphoplasty and vertebroplasty?

Vertebroplasty and kyphoplasty are used to treat painful vertebral compression fractures that result from osteoporosis, a bone tumor, multiple myeloma, or vertebral hemangioma. You may not have the procedure if you have:

• A bone infection (osteomyelitis)
• Non-painful, stable compression fractures
• Bleeding disorders
• Allergy to medications used for the procedure
• Fracture fragment or tumor in the spinal canal
• Chronic or old fractures

The surgeon will take a complete medical history, perform a physical examination, and conduct diagnostic tests (x-rays, bone scan, MRI, and/or CT) to evaluate the VCF. The decision to have surgery will be based on whether or not the fracture is stable or unstable.

What preparations are involved?

Before having a vertebroplasty or kyphoplasty procedure, you are scheduled for presurgical tests, which include a chest x-ray, electrocardiogram, and blood tests. After you fill out all paperwork, and sign consent forms, you must stop taking any medications that thin the blood one week before surgery (ibuprofen, blood-thinners, aspirin, and Nuprin). You cannot eat or drink after midnight the night before your surgery. When you arrive at the surgical center, you change into a gown, and the nurse places an IV catheter in your arm.

What happens during the surgery?

While both procedures are similar, they do differ slightly. After the patient is sedated, the skin is cleaned. A local anesthetic is used to numb the skin of the back. A half-inch incision is made over the fractured bone, and the procedure needle is guided into the bone using real-time x-ray guidance. With kyphoplasty, the balloon is inflated to raise the vertebra back to normal height. The bone cement is injected afterwards. With vertebroplasty, the bone cement is injected into the bone without the balloon. Afterwards, the needles are withdrawn, and the incision is closed with sutures or steri-strips.

Which works best, vertebroplasty or kyphoplasty?

According to a recent study involving vertebroplasty patients, the success rate for pain relief was 90%, but the wedge deformities were not corrected. Regarding kyphoplasty, a recent research study found that all patients had improved pain levels after the procedure. In addition, a study comparing the two procedures found that some pain relief was noted in 87% of vertebroplasty patients and 92% of kyphoplasty patients, which showed that kyphoplsty was slightly superior to vertebroplasty.

Resources

Ledlie JT, Renfro M: Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg 98(1 Suppl): 36-42, 2003
McCall T, Cole C, & Dailey A (2008). Vertebroplasty and kyphoplasty: a comparative review of efficacy and adverse events. Curr Rev Musculoskelet Med, 1(1), 17-23.
Wong W, Reiley MA, Garfin S: Vertebroplasty/Kyphoplasty. J Women’s Imaging 2(3):117-124, 2000