One of the main restrictions of vertebroplasty is the high injection pressure that is required to inject sufficient cement into a fractured vertebral body. Kyphoplasty can be used to reduce injection pressure by making a void with a balloon tamp. During vertebroplasty, serious complications such as pulmonary embolism and neurologic compression have been reported, which usually occur when uncontrolled excessive pressure is applied to inject bone cement. We devised a technique of making small voids and connections with the fracture gaps to reduce cement delivery pressure during vertebroplasty that involves a simple modification of the conventional technique. The modification of vertebroplasty using a curved probe may be used to control the cement injection easily during the procedures and minimize complications related to cement leakage.
Kyphoplasty ; Pulmonary Embolism ; Vertebroplasty

Osteoporotic vertebral fracture is a disease condition with high morbidity and mortality, whose prevalence rises with mean increase in the life span. Conventional treatments for an osteoporotic vertebral fracture include bed rest, pain medication and brace implementation, but if the patient's pain is severe, cement augmentation procedures, including vertebroplasty and kyphoplasty, are performed. Vertebroplasty and kyphoplasty are relatively easy procedures that have been reported to be effective in controlling acute pain. But, the risk of complication and additional adjacent segment fracture and their superiority over conventional treatment remain debatable. Therefore, the authors have summarized the procedures, complications, and clinical evidence of vertebroplasty and kyphoplasty in this review.
Acute Pain ; Bed Rest ; Braces ; Kyphoplasty* ; Mortality ; Prevalence ; Vertebroplasty*

Kummell's disease is a spinal disorder characterized by delayed post-traumatic collapse of a vertebral body with avascular necrosis. Although definitive treatment for Kummell's disease has not been established, it has been reported that percutaneous vertebroplasty or kyphoplasty has shown good results. However, these procedures are not recommended for severely collapsed vertebral bodies because of the risk of cement leakage or technical difficulties. Authors report a rare case of spontaneous reduction in vertebral height by the insertion of a working cannula into the vertebral body in Kummell's disease.
Catheters ; Fractures, Compression ; Humans ; Kyphoplasty ; Necrosis ; Osteoporosis ; Vertebroplasty

Osteoporotic vertebral compression fractures (OVF) are an increasing public health problem. Cement augmentation (vertebroplasty of kyphoplasty) helps stabilize painful OVF refractory to medical treatment. This stabilization is thought to improve pain and functional outcome. Vertebroplasty consists of injecting cement into a fractured vertebra using a percutaneous transpedicular approach. Balloon kyphoplasty uses an inflatable balloon prior to injecting the cement. Although kyphoplasty is associated with significant improvement of local kyphosis and less cement leakage, this does not result in long-term clinical and functional improvement. Moreover, vertebroplasty is favored by some due to the high cost of kyphoplasty. The injection of cement increases the stiffness of the fracture vertebrae. This can lead, in theory, to adjacent OVF. However, many studies found no increase of subsequent fracture when comparing medical treatment to cement augmentation. Kyphoplasty can have a protective effect due to restoration of sagittal balance.
Fractures, Compression ; Kyphoplasty ; Kyphosis ; Osteoporotic Fractures ; Public Health ; Spine ; Vertebroplasty

OBJECTIVE: There are no strong guidelines on how long or how we should undertake conservative treatment during the acute period of an osteoporotic vertebral compression fracture (VCF). METHODS: We treated 202 patients with conservative treatment on VCF from March 2012 to August 2015. On inclusion criteria, 75 patients (22 males and 53 females) were included in the final analysis. After admission, a transdermal fentanyl patch with low dose (12.5 µg) application was attempted in all patients. In an unresponsive patient, the fentanyl patch was increased by 25 µg. After identifying the tolerable toilet ambulation of the patient without any assistance, hospital discharge was recommended. We classified two patient groups into one favorable group and one unfavorable group and compared several clinical and radiological factors. RESULTS: Among 75 patients, the clinical outcome of 57 patients (76%) was favorable, but that of 18 patients (24%) was unfavorable. In clinical outcomes, the numeric rating scale at 6 and 12 months and Odom's criteria at 12 months was significantly different between the favorable and the unfavorable groups. The dose of the patches used showed statistically significant differences between the two groups (p=0.001). CONCLUSION: The only statistically significant affecting factor for an unfavorable outcome was the use of a higher dose fentanyl patch. Our data inferred that the unresponsiveness to a low-dose fentanyl patch could be helpful to select patients necessary for percutaneous vertebroplasty or kyphoplasty.
Fentanyl* ; Fractures, Compression* ; Humans ; Kyphoplasty ; Male ; Transdermal Patch* ; Vertebroplasty ; Walking

OBJECTIVE: A single balloon extrapedicular kyphoplasty has been introduced as one of the unilateral approaches for thoracic compression fractures; however, the unilateral extrapedicular technique in the lumbar area needs a further understanding of structures in the lumbar area. The purpose of the present study is to describe methods and pitfalls of this procedure based on the anatomy of the lumbar area and to analyze clinical outcome and complications. METHODS: Anatomical evaluation was performed with 2 human cadavers. A retrospective review of unilateral extrapedicular approaches yielded 74 vertebral levels in 55 patients that were treated with unilateral extrapedicular vertebroplasty and kyphoplasty. Radiographic assessment included the restoration rate of vertebral height and correction of kyphosis. RESULTS: Anatomical evaluation indicates that the safe needle entry zone of bone for the extrapedicular approach was located in the supero-lateral aspect of the junction between the pedicle and vertebral body. The unilateral extrapedicular procedure achieved adequate pain relief with a mean decreases in pain severity of 7.25+/-1.5 and 2.0+/-1.4, respectively. Complications were 1 retroperitoneal hematoma, 6 unilateral fillings and 3 epidural leak of the polymethylmethacrylate. CONCLUSION: The method of a unilateral extrapedicular approach in kyphoplasty and vertebroplasty in the lumbar area might be similar to that in thoracic approach using a route via the extrapedicular space. However, different anatomical characteristics of the lumbar area should be considered.
Cadaver ; Fractures, Compression ; Hematoma ; Humans ; Kyphoplasty ; Needles ; Retrospective Studies ; Vertebroplasty

Percutaneous vertebroplasty and balloon kyphoplasty have been accepted as effective treatment modalities for vertebral compression fractures in patients with vertebral metastasis. However, when these procedures are conducted in patients with lytic lesions of the vertebral pedicle, polymethylmethacrylate leakage through the lytic lesions that occurs during percutaneous pediculoplasty can increase the procedural risks due to the immediate vicinity of neural structures. In spite of this risk, there are not many available reports on safer methods of pediculoplasty. Here we report a case of vertebral metastasis in which the pedicle infiltration of cancer was successfully treated by pediculoplasty using a bone filler device that contained thick bone cement during a balloon kyphoplasty procedure.
Fractures, Compression ; Humans ; Kyphoplasty* ; Neoplasm Metastasis ; Polymethyl Methacrylate ; Vertebroplasty

PURPOSE: To compare the outcome of vertebroplasty with kyphoplasty in the treatment of painful osteoporotic vertebral compression fractures. MATERIALS AND METHODS: From May 2002 through April 2004, 55 patients were analyzed. Vertebroplasties were performed on 29 patients under local anesthesia. The patients were divided into two groups: group I consisted of 15 patients who underwent vertebroplasties within two weeks from the onset of the fractures; group II consisted of 14 patients who underwent kyphoplasties after two weeks from the onset of the fractures. Kyphoplasties were performed on 26 patients under general anesthesia. These patients were also divided into two groups, based on the same criteria as those patients who underwent vertebroplasties. For the radiological assessment, we measured the kyphotic angle with Cobb's method and the reduction rate in the anterior, middle, and posterior portions of the vertebral bodies. The clinical results were assessed with the Oswestry Disability Index and Visual Analogue Scale. RESULTS: The reduction rates of the anterior and middle portions of the vertebral bodies were greater than 50 % in patients who underwent vertebroplasties within two weeks from the onset of the fractures and the patients who received kyphoplasty. The reduction rates of the anterior and middle parts of the vertebral bodies in patients who underwent vertebroplasties after two weeks from the onset of the fractures, was much less than in other three groups. There were no significant differences in clinical comparison among the 4 groups: i.e., all the patient had satisfactory results in terms of pain relief and pre-fracture activity levels. CONCLUSION: We obtained better results from kyphoplasties when we compared vertebroplasties with kyphoplasties, regardless of the operation dates. However, when we performed vertebroplasties within two weeks from the onset of the fractures, we obtained radiological results that were similar to those with kyphoplasties. In clinical comparison, there were no statistically significant differences among the 4 groups. The pain scores improved dramatically after the operations and pre-fracture activity levels resumed.
Anesthesia, General ; Anesthesia, Local ; Fractures, Compression* ; Humans ; Kyphoplasty* ; Spine ; Vertebroplasty*

OBJECTIVES: To examine and compare the effects of vertebroplasty or kyphoplasty on change in the vertebral height and kyphotic angle and presence of new vertebral fracture of adjacent level. MATERIALS AND METHODS: A total of 60 patients with vertebral compression fractures or stable burst fractures underwent vertebroplasty or kyphoplasty from Jan, 2007 to April, 2014 were included in the study. Preoperative, postoperative and last follow-up radiographs were analyzed to quantify presence of new vertebral fractures and preoperative and postoperative vertebral height and kyphotic angle at fracture levels were also measured. Changes in the vertebral body height and kyphotic angle at fracture levels were compared for vertebroplasty and kyphoplasty to determine if there was a significant differences. RESULTS: Measurements revealed that vertebroplasty increased vertebral body height at fracture level by an average 5.5mm or or by 33% of preoperative height and reduced local kyphotic angle by an average 3.5 degrees and kyphoplasty increased vertebral body height at fracture level by an average 5.8mm or by 36% of preoperative height and reduced local kyphotic angel by an average 3.6 degrees. New vertebral fractures occurred in 8 patients (24%) after vertebroplasty and 4 patients (14%) after kyphoplasty. CONCLUSION: There was no significant statistically greater improvement of changes in the vertebral body height at fracture level and kyphotic angle found with vertebroplasty and kyphoplasty. But the vertebroplasty has statistically greater risk of new fracture than kyphoplasty.
Body Height ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphoplasty ; Vertebroplasty

INTRODUCTION: We found a spontaneous fusion at adjacent vertebrae after percutaneous vertebroplasty (PVP) or kyphoplasty in osteoporotic compression fractures and analyze the radiologic & clinical characteristics. MATERIALS & METHODS: Between January 2000 and December 2011, 555 patients were treated with PVP or kyphoplasty for osteoporotic compression fracture in our department. We classified the spontaneous fusion as two groups. One is solid spontaneous fusion group with at least three cortical continuity to adjacent vertebrae, the other is partially fusion group which progressed fusion compared to previous radiologic finding. We reviewed the plain film and analyzed the radiologic characteristics of those patients with duration of fusion, location and extent of fused segments. A clinical characteristic by visual analogue score (VAS) compared to our previous report was checked. RESULTS: Among them, 54 patients (9.7%) had an solid spontaneous fusion and 43 patients (7.7%) had partially fused on plane image. In solid fusion group, the average duration of fusion was 19 months ranged of 3 to 48 months. Forty six cases (85%) of solid fusion patients had occurred with proximal adjacent vertebrae and 7 cases (13%) had proximal with distal adjacent vertebrae. Forty one cases (76%) of spontaneous fusion occurred within 1 segment and 13 cases within multiple segments. The most cases of solid fusion group were occurred at thoracolumbar junction (40 patients, 74%). Mean VAS score of solid fusion group was 2.0 at final follow-up and were analyzed relatively low score compared to mean VAS of our previous report (2.0, 2.8 respectively). CONCLUSION: After percutaneous vertebroplasty or kyphoplasty in osteoporotic compression fracture, unpredictable spontaneous fusion could develop more than 10% rate, especially with proximal vertebra within 1 segment at thoracolumbar junction in radiologic aspect. Clinically, patients with spontaneous fusion had a tendency of more reduced pain than others.
Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphoplasty ; Spine ; Vertebroplasty