Vertebroplasty and kyphoplasty: a comprehensive review

2005 ◽  
Vol 18 (3) ◽  
pp. 1-9 ◽  
Author(s):  
Allen W. Burton ◽  
Laurence D. Rhines ◽  
Ehud Mendel
Keyword(s):  
Cord Compression ◽  
Vertebral Compression Fractures ◽  
Cardiovascular Collapse ◽  
Nerve Root Compression ◽  
Vertebral Metastasis ◽  
New Techniques ◽  
Technical Aspects ◽  
Benefit Ratio ◽  
Comprehensive Review ◽  
Compression Fractures

Vertebroplasty and kyphoplasty are relatively new techniques used to treat painful vertebral compression fractures (VCFs). Vertebroplasty is the injection of bone cement, generally polymethyl methacrylate (PMMA), into a vertebral body (VB). Kyphoplasty is the placement of balloons (called “tamps”) into the VB, followed by an inflation/deflation sequence to create a cavity prior to the cement injection. These procedures are most often performed in a percutaneous fashion on an outpatient (or short stay) basis. The mechanism of action is unknown, but it is postulated that stabilization of the fracture leads to analgesia. The procedures are indicated for painful VCFs due to osteoporosis or malignancy, and for painful hemangiomas. These procedures may be efficacious in treating painful vertebral metastasis and traumatic VCFs. Much evidence favors the use of these procedures for pain associated with the aforementioned disorders. The risks associated with the procedures are low but serious complications can occur. These risks include spinal cord compression, nerve root compression, venous embolism, and pulmonary embolism including cardiovascular collapse. The risk/benefit ratio appears to be favorable in carefully selected patients. The technical aspects of the procedures are presented in detail along with guidelines for patient selection. A comprehensive review of the evidence for the procedures and the reported complications is presented.

Use of percutaneous kyphoplasty to treat painful vertebral compression fractures (VCF) in solid tumors

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20568-e20568
Author(s):  
T. N. Elrafei ◽  
M. Hazza ◽  
N. Tindel
Keyword(s):  
Pain Score ◽  
Solid Tumors ◽  
Cord Compression ◽  
Vertebral Compression Fractures ◽  
Percutaneous Injection ◽  
Safety And Efficacy ◽  
Compression Fractures ◽  
Cancer Group ◽  
Visual Analog Pain Score ◽  
Benign Group

e20568 Background: Vertebral compression fractures are a major source of morbidity in metastatic carcinoma. Kyphoplasty involves inflation of a balloon for painful kyphotic deformity restoring the vertebral body to its original height and creating a cavity for percutaneous injection of polymethylmethacrylate (PMMA). Contraindications include epidural spinal cord compression. Although it is FDA approved for cancer-associated VCF most of the data is in the myeloma population. Methods: We retrospectively assessed by electronic medical records the safety and efficacy of kyphoplasties performed by the orthopedic spine service in a single institution between 12/03 and 2/08. We identified those patients who had kyphoplasty as the only spine procedure and excluded those patients with incomplete documentation of pain scores. Comparison was made between patients selected for pathologic compression fractures and benign compression fractures secondary to trauma or osteoporosis. Results: Review of 447 consecutive orthopedic spine cases identified 40 kyphoplasty patients, 30 of which met the inclusion criteria - 21 with benign compression fractures secondary to osteoporosis/trauma and 9 with malignant disease (3 breast CA, 2 lung, 1 cervix, 1 RCC, 2 myeloma). 49 kyphoplasties and 23 concurrent spine biopsies were performed in this group. Median age was in the cancer group was 55 (37–81) vs. 68(41–93) in benign group. One patient had prior radiation in the cancer group. The average preoperative visual analog pain score was 7 (range 3–9) and postoperative pain score was 2.0 (0–9) in the cancer group. The average preoperative visual analog pain score 6.8 (0–9) and post-operative score was 0.8 (0–4) in the benign group. Most procedures did not require general anesthesia. There were no reported PMMA extravasations, and no hematologic or neurologic complications in either group. Conclusions: Kyphoplasty provided marked pain relief in patients with VCF secondary to solid tumors and myeloma. The results are comparable to non-cancer population in safety and efficacy, and are feasible in selected cancer patients with pain due to pathologic compression fractures. [Table: see text]

Bone density and bone health alteration in boys with Duchenne Muscular Dystrophy: a prospective observational study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Renu Suthar ◽  
B. V. Chaithanya Reddy ◽  
Manisha Malviya ◽  
Titiksha Sirari ◽  
Savita Verma Attri ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Bone Health ◽  
Prospective Observational Study ◽  
Bone Fractures ◽  
Long Bone ◽  
Vertebral Compression Fractures ◽  
Serum Osteocalcin ◽  
Z Score ◽  
X Ray ◽  
Compression Fractures

Abstract Objectives Boys with Duchenne Muscular Dystrophy (DMD) are at increased risk for compromised bone health, manifesting as low-impact trauma long bone fractures and vertebral compression fractures. Methods In a prospective observational study, we studied bone health parameters in North Indian boys with DMD. We consecutively enrolled ambulatory boys with DMD on glucocorticoid therapy. Bone health was evaluated with X-ray spine, Dual-energy X-ray absorptiometry (DXA), serum calcium, vitamin D3 (25[OH]D), 1,25-dihyroxyvitamin D3 (1,25[OH]2D3), serum osteocalcin, osteopontin, and N terminal telopeptide of type 1 collagen (Ntx) levels. Results A total of 76 boys with DMD were enrolled. The median age was 8.5 (interquartile range [IQR] 7.04–10.77) years. Among these, seven (9.2%) boys had long bone fractures, and four (5.3%) had vertebral compression fractures. Fifty-four (71%) boys underwent DXA scan, and among these 31 (57%) had low bone mineral density (BMD, ≤−2 z-score) at the lumbar spine. The mean BMD z-score at the lumbar spine was −2.3 (95% confidence interval [CI] = −1.8, −2.8), and at the femoral neck was −2.5 (95% CI = −2, −2.9). 25(OH)D levels were deficient in 68 (89.5%, n=76) boys, and 1,25(OH)2D3 levels were deficient in all. Mean serum osteocalcin levels were 0.68 ± 0.38 ng/mL (n=54), serum osteopontin levels were 8.6 ± 4.6 pg/mL (n=54) and serum Ntx levels were 891 ± 476 nmol/L (n=54). Boys with low BMD received glucocorticoids for longer duration, in comparison to those with normal BMD (median, IQR [16.9 (6–34) months vs. 7.8 (4.8–13.4) months]; p=0.04). Conclusions Bone health is compromised in North Indian boys with DMD. BMD at the lumbar spine is reduced in more than half of boys with DMD and nearly all had vitamin D deficiency on regular vitamin D supplements. Longer duration of glucocorticoid therapy is a risk factor for low BMD in our cohort.

Sign in / Sign up

Export Citation Format

Share Document