Vertebral Body Compression Fractures Adversely Impact Overall Health 

An estimated 700,000 pathological vertebral body compression fractures occur in the United States each year. Of these, more than one-third become chronically painful. The majority of these fractures (about 85%) are the result of primary osteoporosis; the remainder are due to secondary osteoporosis or osteolytic spinal metastases. These compression fractures lead to progressive deformity and changes in spinal biomechanics and are believed to contribute to increased risk of further fracture. Whether the fracture is painful or not, the spinal deformity caused by two or more fractures dramatically impacts health, daily living and medical costs through loss of lung capacity, reduced mobility, chronic pain, loss of appetite and/or clinical depression. With each osteoporotic vertebral compression fracture, a 9% loss in predicted forced vital capacity and a 15% age-adjusted increase in mortality can be expected.

Traditionally, vertebral body compression fractures were treated medically and rarely with surgical modalities. Unfortunately, the medical management of painful fractures (bed rest, hospitalization, narcotic analgesics and bracing) does nothing to restore spinal alignment and compounds problems associated with osteoporosis. Due to the poor quality of osteoporotic bone and the inherent risks and invasive nature of surgical treatment of vertebral body compression fractures, the procedure has been limited to cases in which there is concurrent spinal instability or neurologic deficit.

Kyphoplasty is an innovative technique that combines vertebroplasty with balloon catheter technology developed for angioplasty. The procedure shows great promise in the treatment of painful, progressive osteoporotic or osteolytic vertebral compression fractures.

Figure 1. Vertebral compression fracture

Kyphoplasty involves extra- or transpedicular cannulation of the vertebral body under fluoroscopic guidance, followed by insertion of an inflatable bone tamp (Figure 2).

Figure 2. Insertion of inflatable bone tamp

Once inflated, the tamp restores the vertebral body toward its original height, while creating a cavity to be filled with bone cement. Cement is injected under relatively low pressure (see Figures 3 through 6 below).

Figure 3. Balloon inflation

Figure 4. Cavity is filled with bone cement

Figure 5. Bone tamp is removed

Figure 6. Bone tamp and inflatable balloon

Vertebroplasty, from which the kyphoplasty technique evolved, was developed in response to limited results of medical and surgical modalities to stabilize and strengthen collapsed vertebral bodies. Interventional neuroradiologists, first in France and then in the United States, began transpedicular percutaneous bone cement injections in 1986. Vertebroplasty offers significant benefits: reduced or eliminated fracture pain, prevention of further collapse, a rapid return to mobility and prevention of bone loss caused by bed rest. However, it does not address spinal deformity. It also requires high-pressure cement injection using low-viscosity cement, which leads to cement leaks in 30-80% of procedures, according to recent studies.

Kyphoplasty has several potential advantages over vertebroplasty. It restores vertebral body height with a low risk of cement extravasation. Kyphoplasty is well tolerated and is associated with statistically significant improvements in pain and function.