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Percutaneous vertebroplasty, kyphoplasty and lordoplasty: implications for the anesthesiologist

Luginbühl, Martin

Current Opinion in Anaesthesiology: August 2008 - Volume 21 - Issue 4 - p 504–513
doi: 10.1097/ACO.0b013e328303be62
Anesthesia outside the operating room: Edited by Francis Bonnet
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Purpose of review Vertebroplasty, kyphoplasty and lordoplasty are minimally invasive procedures mainly performed for refractory pain due to osteoporotic vertebral body fractures. This review summarizes recent findings on outcome, complications and their impact on anesthetic management.

Recent findings Despite an increasing number of publications on surgical technique, therapeutic efficacy and side effects of these interventions, anesthetic management per se is hardly investigated. All three treatments provide similar pain relief. Adverse effects include local cement leakage and new fractures adjacent to augmented vertebrae. Asymptomatic pulmonary cement embolism occurs in 4.6–6.8% of patients depending on cement viscosity, injection pressure and number of injected vertebrae. Potentially life-threatening embolism of cement or fat may occur. Kyphoplasty and lordoplasty aim at correcting vertebral deformity and are equally effective; lordoplasty is substantially less expensive, however. The incidence of systemic cement or fat embolism is similar to that in vertebroplasty. Whereas vertebroplasty is mostly performed under local anesthesia and sedation, general anesthesia is required for kyphoplasty and lordoplasty. The anesthetic regimen follows the principles of anesthesia in the elderly population.

Summary Vertebroplasty, kyphoplasty and lordoplasty are effective minimally invasive treatments for stable vertebral compression fractures without compression of the spinal canal. The anesthesiologist must be prepared to manage systemic cement or fat embolism.

Department of Anesthesiology, University Hospital, Bern, Switzerland

Correspondence to PD Dr med. Martin Luginbühl, Head of Anesthesia for Orthopedic and Hand Surgery, Consultant Anaesthesiologist, Department of Anaesthesiology, University Hospital, CH-3010 Bern, Switzerland Tel: +41 31 632 27 19; fax: +41 31 632 05 54; e-mail: martin.luginbuehl@dkf.unibe.ch

© 2008 Lippincott Williams & Wilkins, Inc.