Background: Both vertebroplasty and balloon kyphoplasty have been described for treatment of
vertebral compression fractures. Vertebroplasty is known for its high leakage rate compared with
balloon kyphoplasty. In vitro studies have shown that high-viscosity cements significantly decrease
the incidence of cement leakage and increase the predictability of cement fill in cancellous bonelike
substrates compared with low-viscosity cements.
Objective: This study compares the incidence and pattern of cement leakage in cases treated with
standard balloon kyphoplasty (BKP) and a novel vertebral augmentation procedure, radiofrequency
targeted vertebral augmentation (RF-TVA).
Study Design: Retrospective evaluation of postoperative radiographs.
Setting: Single center inpatient and outpatient population.
Methods: Two methods of vertebral augmentation were utilized. Conventional bipedicular BKP
and RF-TVA, a novel unipedicular technique which uses a navigational osteotome to create targeted,
bone sparing cavities and RF energy to deliver an ultra-high viscosity cement at a consistent rate via
a remote controlled, automated hydraulic delivery system. Postoperative radiographs of patients
treated with the 2 techniques were critically analyzed for the incidence and location of cement
leakage. Eighty consecutive patients with 106 treated levels were included. Thirty-five patients with
49 levels in the BKP and 45 patients with 57 levels in RF-TVA group were evaluated.
Results: Leakages less than 1-2 mm were not reported since they may not represent any
clinical significance. In the BKP group, 6 leakages (12%) were reported (3 discal, 2 venous, one
paravaertebral, and no epidural). In the RF-TVA group, a total of 3 leakages (5%) were reported,
(one discal, 2 venous, no paravaertebral or epidural). Using contingency analysis for leakage per
level, there was a statistical difference for leakage between RF-TVA and standard BKP, P < 0.01.
Limitations: Retrospective study, single center.
Conclusions: The RF-TVA technique may provide an approximately 50% reduction in leakage
rate when compared to standard BKP. This may be related to the combination of controlled
delivery of radiofrequency activated (high viscosity) cement at a fixed, low rate of delivery into sitespecific channels created using a navigational osteotome. Additionally, based on the unipedicular
access and remotely controlled cement delivery RF-TVA may decrease procedural invasiveness and
physician radiation exposure, respectively.
Institutional Review: This study was approved by the Institutional Review Board.
Key words: Balloon kyphoplasty, radiofrequency targeted vertebral augmentation, compression
fractures, cement leakage
Comparison Between Radiofrequency
Targeted Vertebral Augmentation and Balloon
Kyphoplasty in the Treatment of Vertebral
Compression Fractures: Addressing Factors that
Affect Cement Extravasation and Distribution