Current Diagnosis and Treatment Physical Medicine and Rehabilitation (Current Diagnosis & Treatment) by Ian Maitin

Author:Ian Maitin [Maitin, Ian]
Language: eng
Format: azw3
Publisher: McGraw-Hill Education
Published: 2015-01-04T16:00:00+00:00

VERTEBROPLASTY & KYPHOPLASTY

General Considerations

Traditional treatment of painful compression fractures of spine has been almost exclusively nonoperative, including bed rest, nonsteroidal antiinflammatory drugs, oral or parenteral analgesics, muscle relaxants, and physical therapy with external back bracing. Surgical treatment of symptomatic vertebral compression fractures has consisted, in the past, of reduction and internal fixation using an open anterior or posterior approach. In the treatment of symptomatic vertebral compression fractures, surgical procedures have traditionally been reserved for actual or impending neurologic compromise. Although most patients have favorable outcomes with nonoperative treatment, some fail to respond and suffer from prolonged pain and immobility that can persist for life.

Vertebroplasty is a minimally invasive procedure used in the treatment of pain and instability caused by vertebral body compression fractures. The procedure involves percutaneous structural reinforcement of the compressed vertebral body using polymethylmethacrylate acrylic cement. The cement hardens upon delivery into the vertebral body, providing support and stabilization of the vertebral fracture or compression by eliminating micromovement of the fracture fragments. The main goal of vertebroplasty is to provide pain relief from the compression fracture by either stabilizing the fracture or destroying pain fibers from its exothermic reaction. In experienced hands vertebroplasty is a safe and effective procedure for rapid pain relief of acute vertebral compression fractures resulting from osteoporosis, hemangiomas, and metastatic tumor.

Kyphoplasty was developed to restore vertebral height and spinal alignment that is not possible with vertebroplasty. Kyphoplasty involves placing a catheter with a balloon tip through a large-gauge needle into the vertebral body. The balloon is then inflated, which partially restores vertebral height and creates a cavity for cement injection. The balloon is deflated and removed, after which the cement in injected into the vertebral body. In addition to restoring vertebral height and spinal alignment, kyphoplasty allows for the injection of cement under low pressure potentially reducing the risk for cement extrusion. However, kyphoplasty is performed under general anesthesia in an operating room and requires considerably more time to complete than vertebroplasty. The primary goal of both procedures is pain relief, which they both equally provide to patients with compression fractures.

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