Vertebroplasty and kyphoplasty: Case presentation, complications, and their prevention

Objective. To describe vertebroplasty and kyphoplasty, which are relatively new techniques used to treat painful vertebral compression fractures. Design Setting Patients. This article briefly reviews the procedural indications, technical aspects of the procedure, and strategies for complication avoidance. Results. Percutaneous vertebroplasty is the injection of a vertebral body with bone cement, generally polymethylmethacrylate. Kyphoplasty is the placement of balloons (called "tamps") into the vertebral body with an inflation/deflation sequence to create a cavity prior to the cement injection. These procedures are most often performed in a percutaneous fashion on an outpatient (or short stay) basis. The mechanism of action is unknown, but it is postulated that stabilization of the fracture leads to analgesia. The procedure is indicated for painful vertebral compression fractures due to osteoporosis or malignancy, and painful hemangiomas. The procedure has efficacy in painful vertebral metastasis and traumatic compression fractures. Much evidence favors the use of this procedure for pain associated with these disorders. The overall risks of the procedure are low but serious complications can occur. The serious complications include spinal cord compression, nerve root compression, venous embolism, pulmonary embolism including cardiovascular collapse, and others. With good patient selection and careful technique, these complications are avoidable, making the risk-to-benefit ratio highly favorable. Conclusions. Vertebroplasty and kyphoplasty are effective and safe techniques used to treat painful spinal fractures.