Vertebral augmentation

Vertebral augmentation includes both:

  • vertebroplasty - injection of polymethylmethacrylate cement into vertebral body
  • kyphoplasty - creation of osseous channel(s), followed by injection of polymethylmethacrylate cement

Pre-procedural evaluation and patient management

Indications

Palliation of debilitating pain related to acute/subacute vertebral compression fractures. This may include:

  • osteoporotic (fragility) fracture[1]
  • pathologic fracture[2]
    • benign - hemangioma
    • malignant - metastasis

Conservative tx (bracing, pain medication) is an alternative, although may result in prolonged immobility and/or unwanted interaction with narcotics

Contraindications[2]

  • coagulation disorder
  • severe pulmonary insufficiency
  • compromise of the posterior wall vertebral body or walls of the vertebral pedicle
  • active or incomplete treated regional infection
  • allergy to cement components

Technique

Immediate and long-term complications

Overall, complication rates are low (<1%) - m/c cement leakage, infection, and drug reactions. [1]

Related to placement [2]

  • pneumothorax
  • rib fx - in setting of diffuse osteopenia, especially thoracic procedures, due to downward force exerted during cannula insertion
  • pedicle fx
  • intercostal neuralgia
  • compression of the spinal cord with paralysis or loss of feeling

Related to cement extravasation from vertebral body * **

  • vascular embolization → PE, myocardial infarction
  • epidural plexus, nerve entrapment and dysphasia
  • cement within the intervertebral disc

* = extravasation is common, although mostly clinically silent [1]
** = rate of leakage lower with kyphoplasty vs vertebroplasty, presumably 2/2 channels [1]

Related to altered spinal biomechanics

  • collapse of a vertebra adjacent to the one injected 2/2 osteoporotic disease

Post-procedural evaluation and patient management

References

  1. 1.0 1.1 1.2 1.3 Marcia S, Muto M, Hirsch JA, Chandra RV, Carter N, Crivelli P, Piras E, Saba L. What is the role of vertebral augmentation for osteoporotic fractures? A review of the recent literature. (2018) Neuroradiology. 60 (8): 777-783. doi:10.1007/s00234-018-2042-0 - Pubmed
  2. 2.0 2.1 2.2 StabiliT® Vertebral Augmentation system brochure, Merit Medical, Accessed Sept 22, 2018.

Contributing Authors

BGG, Kevin Liu