Vertebroplasty and kyphoplasty

New ways to treat osteoporotic fractures have emerged with vertebroplasty and kyphoplasty. During the minimally invasive interventions, cement is injected into the fractured bone whereby patients can be immediately relieved from pain. With kyphoplasty, the spine can even be brought back to its original upright position.

The treatment of osteoporosis-related spine fractures has for a long time been limited to medication, a brace, or invasive spinal surgery. In the past decade, however, clinical research in osteoporosis has expanded enormously, leading to the emergence of two new promising treatments for this bone disease: vertebroplasty and kyphoplasty. Reports have revealed a good success rate of these innovative techniques.

A serious public health problem

Osteoporosis is the most common bone disease in the U.S. According to the National Osteoporosis Foundation, it is a threat for about 44 million Americans over 50 years of age. Currently it is estimated that 10 million people have osteoporosis, of which 80% are female – this is due to accelerated bone loss at menopause. Osteoporosis is responsible for as many as 1.5 million fractures annually, resulting in an estimated annual cost to national health care of $10-15 billion dollars.

The disease is characterized by structural deterioration of bone tissue, resulting in an increased risk of fracture, especially of the hip, spine, and wrist. Painful vertebral compression fractures (VCFs) can be mostly attributed to osteoporosis. Due to the absence of symptoms, osteoporosis is often only detected after a fracture has occurred. Osteoporosis, therefore, is often referred to as a “silent disease”.

Stabilizing vertebral compression fractures

Traditionally, VCFs were treated with medication and only rarely with surgical interventions. Vertebroplasty and kyphoplasty have now expanded the spectrum of therapeutic options. They are minimally invasive interventions where polymethylmethacrylate (PMMA) is injected into the fractured bone. Both treatments stabilize the fracture and provide immediate relief from pain. Most patients can even go home the same day.

During vertebroplasty, a bone biopsy needle is inserted into the center of the vertebral body under X-ray guidance. Once positioned, the cement is injected through the needle into the spine. After a few minutes, the cement solidifies, becoming even harder than the natural bone. Kyphoplasty includes an additional step. A balloon is inserted through the tube and inflated. The void this creates is then filled up with PMMA under low pressure. The great advantage of this procedure is that it offers the possibility of correcting the deformation of the bone and of bringing the spine back to its original upright position.

Benefits of the procedures include:

• Patients can quickly return to their normal daily activities
• Surgical time is short
• Excellent height restoration can be achieved with kyphoplasty
• Procedure is usually possible under local anesthesia
• No bracing required

An encouraging development for osteoporosis treatment

Both vertebroplasty and kyphoplasty are not entirely risk-free. There is a small risk of cement leakage or irritation of the spinal cord or nerves. Kyphoplasty seems to allow a more controlled cement injection. In addition, the technique is not appropriate for young patients, patients with spinal curvature, or patients who suffer from spinal stenosis. Occasionally, individuals who have been treated with these techniques complain of pain after the procedure.

Nevertheless, the emergence of vertebroplasty and kyphoplasty is a milestone in osteoporosis therapy. The latter has been shown to restore height in 70% of VCFs and studies report a high success rate. Currently, studies are underway to compare both techniques.