Vertebroplasty Vs. Kyphoplasty: Who Wins?
Vertebral compression fractures can create a challenging state of chronic pain and disability. The challenge is for both the physician who is scratching his head and for the tearful woman who do not get relief from a conservative treatment plan of physical therapy, bracing, and medications.At this point, it is good to have options. One treatment option is called vertebroplasty, involving the injection of cement into the vertebral body.This procedure is thought to stabilize the fracture. A kyphoplasty is a bit different because an inflatable bone “jack” is inserted before the cement is injected. By jacking up the crushed bone, a space is created for the cement (an important point to consider later). Before sticking needles in her back, our friend with a broken back needs to consider the benefits and risks.
Vertebroplasty has been used and studied for the past decade. Overall the studies report that at least 60% of the patients who had this procedure had improved pain control and function. Some argue that these favorable results can be as a result of the placebo effect. Ongoing trials are still being done to clear this issue up. Cement leakage is the most common cause of complications. Loose pieces of cement floating around can lead to serious problems. These major complications are rare, but do exist. So, vertebroplasty is incompletely studied and can lead to dangerous cement leaks. Is this the best option?
Next option please…Kyphoplasty, a much newer technique, offers a more costly and complicated procedure with potentially better outcomes than seen with vertebroplasties.The first large study of kyphoplasties was preformed between 1998 and 2000 with 1439 patients. The results were promising, a 90% success rate with a 0.2% complication rate. Cement leakage is less likely due to the space created by the bone “jack” (remember, vertebroplasty does not use a “jack”) allowing for placement of thicker cement that is less likely to leak. Pain relief is achieved by restoring the shape of the bone and correction of the misalignment. Is this the best option?
Vertebroplasty or Kyphoplasty… If I were guiding you in this decision, I would ask myself, “What if you were my mother?” That’s right, what would I choose for my own mother? Hands down, Kyphoplasty wins. This procedure has a better chance at correcting the misalignment, has less potential for leaking cement, and has great results. Both procedures are risky. Let’s face it. Anytime a needle gets shoved into the spine, disaster can strike. I am usually most worried about infection when it comes to needles. Now, back to our poor lady with a broken back, the options are few but promising. Whichever she decides, the goal is always to relieve pain, improve function, and do no harm. When considering any option, one must understand the goals, the potential benefits, and the potential risks.
Spine, 2007, Vol. 28, Num. 15S, pgs S45-S53
Spine, 2008, Vol 33, Num. 6, pgs 579-580
One Response to “Vertebroplasty Vs. Kyphoplasty: Who Wins?”
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Pain is not releived by restoring the shape, it is releived by iommobilization of the fractured fragments.
With kyphoplasty in stead of restoring the height, all is done is making a big sphere in the osteoporotic milieu at the expense of surrounding disc spaces and adjacent vertebrae. Once solid cement is deposited into the sphere, this becomes the strongest point in the whole spine, stronger than any vertebra, therefore being the center around future collapses.
Vertebroplasty with injecting cement to 1. immobilize the fractured fragments and 2. restore the pre-fracture vertebral “sterength” is what is achieved.