Controversial issues in kyphoplasty and vertebroplasty in osteoporotic vertebral fractures.
Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed for many years for the treatment of osteoporotic vertebral fractures. The purpose of this review is to resolve the controversial issues raised by the two randomized trials that claimed no difference between VP and SHAM procedure. In particular we compare nonsurgical management (NSM) and KP and VP, in terms of clinical parameters (pain, disability, quality of life, and new fractures), cost-effectiveness, radiological variables (kyphosis correction and vertebral height restoration), and VP versus KP for cement extravasation and complications profile. Cement types and optimal filling are analyzed and technological innovations are presented. Finally unipedicular/bipedicular techniques are compared. Conclusion. VP and KP are superior to NSM in clinical and radiological parameters and probably more cost-effective. KP is superior to VP in sagittal balance improvement and cement leaking. Complications are rare but serious adverse events have been described, so caution should be exerted. Unilateral procedures should be pursued whenever feasible. Upcoming randomized trials (CEEP, OSTEO-6, STIC-2, and VERTOS IV) will provide the missing link.
H. Lee Moffitt Cancer Center & Research Institute, Neuro-Oncology Program and Department of NeuroOncology and Orthopaedics, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL 33647, USA ; General Oncological Hospital Kifisias "Agioi Anargyroi", Athens, Greece.
Ioannis D
ID
Papanastassiou
H. Lee Moffitt Cancer Center & Research Institute, Neuro-Oncology Program and Department of NeuroOncology and Orthopaedics, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL 33647, USA.
Andreas
A
Filis
"Andreas Syngros" Hospital, 16121 Athens, Greece.
Maria A
MA
Gerochristou
H. Lee Moffitt Cancer Center & Research Institute, Neuro-Oncology Program and Department of NeuroOncology and Orthopaedics, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL 33647, USA.
Frank D
FD
Vrionis
D000818:Animals; D006801:Humans; D058498:Kyphoplasty / Q000009:adverse effects / Q000379:methods; D058866:Osteoporotic Fractures / Q000601:surgery*; D013124:Spinal Injuries / Q000473:pathology / Q000601:surgery*; D013131:Spine / Q000601:surgery*