Abstract
Kyphoplasty is a new therapeutic approach that was developed for minimally invasive
augmentation of osteoporotic vertebral fractures. In contrast to vertebroplasty, kyphoplasty
enables age-dependent fracture reduction by means of pressure-controlled inflation
of a balloon that is inserted transpedicularly into the cancellous bone of the fractured
vertebral body. The cavity that remains after the balloon has been removed is filled
with augmentation material for retention. The low rate of serious complications, such
as intraspinal material leakage associated with this procedure, justifies attempts
to expand its indication to specific types of traumatic fractures and neoplastic vertebral
collapse due to osteolytic metastases. Along with indications for conventional percutaneous
access, the “semi-open” microsurgical approach also enables kyphoplasty to be applied
to treat more complex vertebral body fractures that are accompanied by compression
of neural structures. The surgical procedures used in kyphoplasty quickly reduce pain
and enable patients to be quickly mobilised by means of stabilising the affected vertebral
body immediately. Interdisciplinary treatment must nonetheless be continued after
kyphoplasty, in order to optimise individual medical treatment and rehabilitation
regarding the underlying disease.
Key words
Osteoporosis - minimally invasive surgery - vertebral fracture - kyphoplasty
References
- 1
Berlemann U, Heini P F.
Perkutane Zementierungstechniken zur Behandlung osteoporotischer Wirbelkörpersinterungen.
Unfallchirurg.
2002;
105
2-8
- 2
Berlemann U, Ferguson S J, Nolte L P, Heini P F.
Adjacent vertebral failure after vertebroplasty.
J Bone Joint Surg [Br].
2002;
84
748-752
- 3
Bernhard J, Heini P F, Villiger P M.
Asymptomatic diffuse pulmonary embolism caused by acrylic cement: an unusual complication
of percutaneous vertebroplasty.
Ann Rheum Dis.
2003;
62
85-86
- 4
Belkoff S M, Mathis J M, Fenton D C, Scribner R M, Reiley M E, Talmadge K.
An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment
of compression fracture.
Spine.
2001;
26
151-156
- 5 Boszczyk B M, Bierschneider M, Robert B, Jaksche H. Treatment of severe osteoporotic
fractures through a microsurgical interlaminary approach. In: Szpalski M, Gunzburg
R (Eds). Vertebral osteoporotic compression fractures. Lippincott WW, Philadelphia
2003; 179-188
- 6
Boszczyk B M, Bierschneider M, Robert B, Jaksche H.
Augmentationstechniken an der Wirbelsäule - Aktueller Stand der Techniken und der
therapeutischen Möglichkeiten.
Orthopädie & Rheuma.
2002;
1
19-26
- 7
Boszczyk B, Bierschneider M, Potulski M, Robert B, Vastmans J, Jaksche H.
Erweitertes Anwendungsspektrum der Kyphoplastie zur Stabilisierung der osteoporotischen
Wirbelfraktur.
Unfallchirurg.
2002;
105
952-957
- 8
Boszczyk B M, Bierschneider M, Schmid K, Robert B, Jaksche H.
Kyphoplastik im konventionellen und halboffenen Verfahren.
Orthopäde.
(in press).
- 9
Chen H L, Wong C S, Ho S T, Chang F L, Hsu C H, Wu C T.
A lethal pulmonary embolism during percutaneous vertebroplasty.
Anesth Analg.
2002;
95
1060-1062
- 10
Davis J W, Grove J S, Wasnich R D, Ross P D.
Spatial relationships between prevalent and incident spine fractures.
Bone.
1999;
24
261-264
- 11
Dudeney S, Lieberman I H, Reinhardt M K, Hussein M.
Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result
of multiple myeloma.
J Clin Oncol.
2002;
20
2382-2387
- 12
Fourney D R, Schomer D F, Nader R, Chlan-Fourney J, Suki D, Ahrar K, Rhines L D, Gokaslan Z L.
Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in
cancer patients.
J Neurosurg (Spine).
2003;
98
21-30
- 13
Garfin S R, Hansen A Y, Reiley M A.
Kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression
fractures.
Spine.
2001;
26
1511-1515
- 14
Garfin S R, Lin G, Lieberman I, Phillips F, Truumees E.
Retrospective analysis of the outcomes of balloon kyphoplasty to treat vertebral body
compression fracture refractory to medical management (Abstract).
Eur Spine J.
2001;
10
S 7-S 8
- 15
Harrington K D.
Major neurological complications following percutaneous vertebroplasty with polymethylmethacrylate.
J Bone Joint Surg [Am].
2001;
84
1070-1073
- 16
Heini P F, Berlemann U.
Bone substitutes in vertebroplasty.
Eur Spine J.
2001;
10
S 205-S 213
- 17
Jang J S, Lee S H, Jung S K.
Pulmonary embolism of polymethylmethacrylate after percutaneous vertebroplasty.
Spine.
2002;
27
E 416-E 418
- 18
Ledlie J T, Renfro M.
Balloon kyphoplasty: One-year outcomes in vertebral body height restoration, chronic
pain and activity levels.
J Neurosurg (Spine).
2003;
98
36-42
- 19
Lee B J, Lee S R, Yoo T Y.
Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate.
Spine.
2002;
27
E 419-E 422
- 20
Lieberman I H, Dudeney S, Reinhardt M K, Bell G.
Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic
vertebral compression fractures.
Spine.
2001;
26
1631-1638
- 21
Magerl F, Aebi M, Gertzbein S D, Harms J, Nazarian S.
A comprehensive classification of thoracic and lumbar injuries.
Eur Spine J.
1994;
3
184-201
- 22
Oner F C, van der Rijt R R, Ramos L MP, Dhert W JA, Verbout A J.
Changes in the disc space after fractures of the thoracolumbar spine.
J Bone Joint Surg [Br].
1998;
80
833-839
- 23
Oner F C, van Gils A PG, Faber A J, Dhert W JA, Verbout A J.
Some complications of common treatment schemes of thoracolumbar spine fractures can
be predicted with magnetic resonance imaging.
Spine.
2002;
27
629-636
- 24
Perez-Higueras A, Alvarez L, Rossi R E, Quinones D, Al-Assir I.
Percutaneous vertebroplasty: long-term clinical and radiological outcome.
Neuroradiology.
2002;
44
950-954
- 25
Padovani B, Kasriel O, Brunner P, Peretti-Viton P.
Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty.
Am J Neuroradiol.
1999;
20
375-377
- 26
Ratliff J, Nguyen T, Heiss J.
Root and spinal cord compression from methylmethacrylate vertebroplasty.
Spine.
2001;
26
E 300-E 302
- 27
Ross P D, Genant H K, Davis J W, Miller P D, Wasnich R D.
Predicting vertebral fracture incidence from prevalent fractures and bone density
among none-black, osteoporotic women.
Osteoporosis Int.
1993;
3
120-126
- 28
Scroop R, Eskridge J, Britz G W.
Paradoxical cerebral embolization of cement during intraoperative vertebroplasty:
case report.
Am J Neuroradiol.
2002;
23
868-870
- 29
Tozzi P, Abdelmoumene Y, Corno A F, Gersbach P A, Hoogewoud H M, von Segesser L K.
Management of pulmonary embolism during acrylic vertebroplasty.
Ann Thorac Surg.
2002;
74
1706-1708
- 30
Wenger W, Markwalder T M.
Surgically controlled, transpedicular methyl methacrylate vertebroplasty with fluoroscopic
guidance.
Acta Neurochir.
1999;
141
625-631
- 31
Wilke H J, Mehnert U, Boszczyk B, Bierschneider M, Jaksche H, Claes L E.
Biomechanical evaluation of vertebro- and kyphoplasty under cyclic loading. (Abstract)
- presented at: The Aging Spine - Swiss Spine Society Basel 2002.
Eur Spine J.
2002;
11
613
- 32
Wilson D R, Myers E R, Mathis J M, Scribner R M, Conta J A, Reiley M A, Talmadge K D,
Hayes W C.
Effect of augmentation on the mechanics of vertebral wedge fractures.
Spine.
2002;
25
158-165
- 33
Wong W, Reiley M, Garfin S.
Vertebroplasty/kyphoplasty.
J Women's Imaging.
2000;
2
117-124
Dr. B. M. Boszczyk
Berufsgenossenschaftliche Unfallklinik Murnau
Prof.-Küntscher-Str. 8
82418 Murnau
Germany
Phone: +49/88 41-48-28 51
Fax: +49/88 41-48-28 54
Email: B.Boszczyk@gmx.net