To describe new treatments for painful osteoporotic compression fractures in light of available scientific literature and clinical experience.
Painful vertebral osteoporotic compression fractures lead to significant morbidity and mortality. This relates to pulmonary dysfunction, eating disorders (nutritional deficits), pain, loss of independence, and mental status change (related to pain and medications). Medications to treat osteoporosis (primarily antiresorptive) do not effectively treat the pain or the fracture, and require over 1 year to reduce the degree of osteoporosis. Kyphoplasty and vertebroplasty are new techniques that help decrease the pain and improve function in fractured vertebrae.
This is a descriptive review of the background leading to vertebroplasty and kyphoplasty, a description of the techniques, a review of the literature, as well as current ongoing studies evaluating kyphoplasty.
Both techniques have had a very high acceptance and use rate. There is 95% improvement in pain and significant improvement in function following treatment by either of these percutaneous techniques. Kyphoplasty improves height of the fractured vertebra, and improves kyphosis by over 50%, if performed within 3 months from the onset of the fracture (onset of pain). There is some height improvement, though not as marked, along with 95% clinical improvement, if the procedure is performed after 3 months. Complications occur with both and relate to cement leakage in both, and cement emboli with vertebroplasty.
Kyphoplasty and vertebroplasty are safe and effective, and have a useful role in the treatment of painful osteoporotic vertebral compression fractures that do not respond to conventional treatments. Kyphoplasty offers the additional advantage of realigning the spinal column and regaining height of the fractured vertebra, which may help decrease the pulmonary, GI, and early morbidity consequences related to these fractures. Both procedures are technically demanding.
From the *University of California, San Diego, California, †SUNY Health Centers, Syracuse, New York, and ‡Berkeley Orthopaedic Medical Group, Inc., Berkeley, California.
Acknowledgment date: July 25, 2000.
First revision date: October 23, 2000.
Acceptance date: July 24, 2001.
Address reprint requests to
Steven R. Garfin, MD
Department of Orthopaedics
UCSD Medical Center
200 West Arbor Drive
San Diego, CA 92103-8894
The KypX balloon bone tamp used for kyphoplasty is approved by the FDA for reduction of fractures in long bones and the spine. Polymethylmethacrylate is approved for use in joint reconstruction. Its use in the spine is off label.