Minimally invasive treatment of osteoporotic vertebral body compression fractures.
BACKGROUND
Seven hundred thousand osteoporotic compression fractures occur yearly. Approximately 260,000 lead to severe pain, and 150,000 require hospital admissions. Associated with the fractures are increased loss of pulmonary function (90% decreased forced vital capacity per fracture level) and an increase in gastrointestinal complications (early satiety, and therefore malnutrition) and increased mortality (greater than that associated with osteoporotic hip fractures). New treatments available for these painful disorders include kyphoplasty and vertebroplasty. The injections of polymethylmethacrylate into the vertebrae (vertebroplasty technique) decrease pain and improve function. Kyphoplasty (percutaneous placement of a balloon tamp to improve height and create a void, and then the filling of this void with cement) improves function, decreases pain and helps realign the spine.


OBJECTIVE
To compare kyphoplasty and vertebroplasty, and assess their various merits, treatment indications, and outcomes.


METHODS
Literature review with presentation of early results of a national, clinical study.


METHODS
Literature review for overview. Retrospective chart/patient review for clinical data presented on kyphoplasty.


RESULTS
Ninety-five percent of individuals treated for painful osteoporotic compression fractures have significant improvement in symptoms and function after kyphoplasty or vertebroplasty. Kyphoplasty improves vertebral body height and kyphotic alignment by 50%, if performed within 3 months of the onset of the fracture collapse.


CONCLUSIONS
Vertebroplasty and kyphoplasty both have roles in the treatment of painful osteoporotic compression fractures. Only kyphoplasty helps improve height and kyphosis, which should help prevent pulmonary and gastrointestinal complications.
Garfin
Steven R
SR
University of California, San Diego, Medical Center, Orthopaedics Department, 200 W. Arbor 8894 Drive, San Diego, CA 92103-8894, USA. Sgarfin@ucsd.edu
Reilley
Mark A
MA
D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures; D010024:Osteoporosis / Q000150:complications*; D016103:Spinal Fractures / Q000209:etiology* / Q000601:surgery*