When are vertebroplasty and balloon kyphoplasty indicated for the treatment of osteoporosis?

Updated: Sep 26, 2019
  • Author: Monique Bethel, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Vertebroplasty and balloon kyphoplasty are indicated in patients with incapacitating and persistent severe focal back pain related to vertebral collapse. Both procedures involve the injection of acrylic cement (methylmethacrylate) into the fractured vertebral body. The procedures are performed under local anesthesia and either fluoroscopic or CT guidance. Both procedures relieve pain; however, in kyphoplasty a balloon tamp is inflated within and between the fracture fragments before the cement is infused, in order to restore vertebral body height (see the images below).

In kyphoplasty, a KyphX inflatable bone tamp is pe In kyphoplasty, a KyphX inflatable bone tamp is percutaneously advanced into the collapsed vertebral body (A). It is then inflated, (B) elevating the depressed endplate, creating a central cavity, and compacting the remaining trabeculae to the periphery. Once the balloon tamp is deflated and withdrawn, the cavity (C) is filled under low pressure with a viscous preparation of methylmethacrylate (D).
Osteoporosis. Lateral radiograph demonstrates mult Osteoporosis. Lateral radiograph demonstrates multiple osteoporotic vertebral compression fractures. Kyphoplasty has been performed at one level.
Osteoporosis. Lateral radiograph of the patient se Osteoporosis. Lateral radiograph of the patient seen in the previous image following kyphoplasty performed at 3 additional levels.

There is still considerable controversy about the efficacy and safety of these procedures. [188] For more information, see Percutaneous Vertebroplasty and Kyphoplasty.


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