Semin intervent Radiol 2008; 25(4): 413-424
DOI: 10.1055/s-0028-1103000
© Thieme Medical Publishers

Osteoporotic Vertebral Compression Fractures and Vertebral Augmentation

Kimi L. Kondo1
  • 1Department of Radiology, University of Colorado Denver, Aurora, Colorado
Further Information

Publication History

Publication Date:
15 December 2008 (online)

ABSTRACT

Vertebral fractures account for ~27% of all osteoporotic fractures in both men and women. The economic burden is substantial and growing: osteoporosis is expected to affect 14 million people by the year 2020. There is substantial morbidity associated with osteoporotic vertebral compression fractures (VCFs) including decreased quality of life, reduced pulmonary function, and increased mortality. Relatively recent additions to the treatment armamentarium include vertebral augmentation using vertebroplasty and kyphoplasty. Numerous retrospective and case studies demonstrate short-term efficacy and low complication rates of vertebroplasty and kyphoplasty in the treatment of osteoporotic VCFs, but controlled trials are needed for validation. The pathophysiology, risk factors, consequences, characteristics, and imaging of osteoporotic VCFs are presented in detail along with a discussion of treatment options and patient selection. Vertebral augmentation is comprehensively reviewed, including the technical aspects of the procedures, contraindications, complications, and clinical outcomes.

REFERENCES

  • 1 National Osteoporosis Foundation .Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2008. Available at: http://www.nof.org/professionals/NOF_Clinicians%20_Guide.pdf Accessed March 26, 2008
  • 2 Burge R, Dawson-Hughes B, Solomon D H, Wong J B, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025.  J Bone Miner Res. 2007;  22 465-475
  • 3 Black D M, Arden N K, Palermo L, Pearson J, Cummings S R. Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group.  J Bone Miner Res. 1999;  14 821-828
  • 4 Lindsay R, Silverman S I, Cooper C et al.. Risk of new vertebral fracture in the year following a fracture.  JAMA. 2001;  285 320-323
  • 5 Riggs B L, Melton L J. Epidemiology of osteoporosis.  Bone. 1995;  17(suppl 1) S505-S511
  • 6 Rao R D, Singrakhia M D. Painful osteoporotic vertebral fracture. Pathogenesis, evaluation, and roles of vertebroplasty and kyphoplasty in its management.  J Bone Joint Surg Am. 2003;  85-A 2010-2022
  • 7 Parfitt A M. Implications of architecture for the pathogenesis and prevention of vertebral fracture.  Bone. 1992;  13(suppl 2) S41-S47
  • 8 Mellish R W, Garrahan N J, Compston J E. Age-related changes in trabecular width and spacing in human iliac crest biopsies.  Bone Miner. 1989;  6 331-338
  • 9 Warming L, Hassager C, Christiansen C. Changes in bone mineral density with age in men and women: a longitudinal study.  Osteoporos Int. 2002;  13 105-112
  • 10 Mathis J M, Barr J D, Belkoff S M, Barr M S, Jensen M E, Deramond H. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures.  AJNR Am J Neuroradiol. 2001;  22 373-381
  • 11 Cauley J A, Hochberg M C, Lui L Y et al.. Long-term risk of incident vertebral fractures.  JAMA. 2007;  298 2761-2767
  • 12 LaFleur J, McAdam-Marx C, Kirkness C, Brixner D I. Clinical risk factors for fracture in postmenopausal osteoporotic women: a review of the recent literature.  Ann Pharmacother. 2008;  42 375-386
  • 13 Nevitt M C, Ross P D, Palermo L, Musliner T, Genant H K, Thompson D E. Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures.  Bone. 1999;  25(5) 613-619
  • 14 Nevitt M C, Cummings S R, Stone K L et al.. Risk factors for a first-incident radiographic vertebral fracture in women > 65 years of age: the study of osteoporotic fractures.  J Bone Miner Res. 2005;  20 131-140
  • 15 Silverman S L. The clinical consequences of vertebral compression fracture.  Bone. 1992;  13(suppl 2) S27-S31
  • 16 Lyritis G P, Mayasis B, Tsakalakos N et al.. The natural history of the osteoporotic vertebral fracture.  Clin Rheumatol. 1989;  8(suppl 2) 66-69
  • 17 Francis R M, Aspray T J, Hide G, Sutcliffe A M, Wilkinson P. Back pain in osteoporotic vertebral fractures. [published online ahead of print December 11, 2007].  Osteoporos Int. Available at: http:__www.springerlink.com_content_1m6l7g6l06584367_fulltext.html Accessed March 30, 2008; 
  • 18 Truumees E, Garfin S R. Patient selection in the treatment of pathologic compression fractures. In: Resnick DK, Garfin SR Vertebroplasy and Kyphoplasty. New York; Thieme 2005: 48-61
  • 19 Gold D T. The clinical impact of vertebral fractures: quality of life in women with osteoporosis.  Bone. 1996;  18(3 suppl) S185-S189
  • 20 Kado D M, Browner W S, Palermo L, Nevitt M C, Genant H K, Cummings S R. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group.  Arch Intern Med. 1999;  159 1215-1220
  • 21 Gold D T. The nonskeletal consequences of osteoporotic fractures. Psychologic and social outcomes.  Rheum Dis Clin North Am. 2001;  27 255-262
  • 22 Lombardi Jr I, Oliveira L M, Mayer A F, Jardim J R, Natour J. Evaluation of pulmonary function and quality of life in women with osteoporosis.  Osteoporos Int. 2005;  16 1247-1253
  • 23 Leech J A, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis in women.  Am Rev Respir Dis. 1990;  141 68-71
  • 24 Culham E G, Jimenez H A, King C E. Thoracic kyphosis, rib mobility, and lung volumes in normal women and women with osteoporosis.  Spine. 1994;  19 1250-1255
  • 25 Schlaich C, Minne H W, Bruckner T et al.. Reduced pulmonary function in patients with spinal osteoporotic fractures.  Osteoporos Int. 1998;  8 261-267
  • 26 Ensrud K E, Thompson D E, Cauley J A et al.. Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass: Fracture Intervention Trial Research Group.  J Am Geriatr Soc. 2000;  48 241-249
  • 27 Adachi J D, Ioannidis G, Berger C et al.. The influence of osteoporotic fractures on health-related quality of life in community-dwelling men and women across Canada.  Osteoporos Int. 2001;  12 903-908
  • 28 Cooper C. The crippling consequences of fractures and their impact on quality of life.  Am J Med. 1997;  103(2A) S12-S17
  • 29 Ismail A A, O'Neill T W, Cooper C et al.. Mortality associated with vertebral deformity in men and women: results from the European Prospective Osteoporosis Study (EPOS).  Osteoporos Int. 1998;  8 291-297
  • 30 Prather H, Watson J O, Gilula L A. Nonoperative management of osteoporotic vertebral compression fractures.  Injury. 2007;  38(suppl 3) S40-S48
  • 31 Agency for Healthcare Research and Quality .U.S. Department of Health and Human Services. Comparative Effectiveness Review No. 12. Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis. AHRQ Publication No. 08–EHC008-EF. Rockville, MD; Agency for Healthcare Research and Quality 2007
  • 32 Sinaki M, Itoi E, Wahner H W et al.. Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of postmenopausal women.  Bone. 2002;  30 836-841
  • 33 Jensen M E, McGraw J K, Cardella J F, Hirsch J A. Position statement on percutaneous vertebral augmentation: a consensus statement developed by the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, American Association of Neurological Surgeons/Congress of Neurological Surgeons, and American Society of Spine Radiology.  AJNR Am J Neuroradiol. 2007;  28 1439-1443
  • 34 Galibert P, Deramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty [in French].  Neurochirurgie. 1987;  33 166-168
  • 35 Jensen M E, Evans A J, Mathis J M, Kallmes D F, Cloft H J, Dion J E. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects.  AJNR Am J Neuroradiol. 1997;  18 1897-1904
  • 36 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 1631-1637
  • 37 Lad S P, Patil C G, Lad E M, Boakye M. Trends in pathological vertebral fractures in the United States: 1993–2004.  J Neurosurg Spine. 2007;  7 305-310
  • 38 Gaughen Jr J R, Jensen M E, Schweickert P A, Kaufmann T J, Marx W F, Kallmes D F. Lack of preoperative spinous process tenderness does not affect clinical success of percutaneous vertebroplasty.  J Vasc Interv Radiol. 2002;  13 1135-1138
  • 39 Gaitanis I N, Carandang G, Phillips F M et al.. Restoring geometric and loading alignment of the thoracic spine with a vertebral compression fracture: effects of balloon (bone tamp) inflation and spinal extension.  Spine J. 2005;  5 45-54
  • 40 Hiwatashi A, Westesson P L. Vertebroplasty for osteoporotic fractures with spinal canal compromise.  AJNR Am J Neuroradiol. 2007;  28 690-692
  • 41 Peh W C, Gilula L A, Peck D D. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures.  Radiology. 2002;  223 121-126
  • 42 Chang W S, Lee S H, Choi W G, Choi G, Jo B J. Unipedicular vertebroplasty for osteoporotic compression fracture using an individualized needle insertion angle.  Clin J Pain. 2007;  23 767-773
  • 43 Chung H J, Chung K J, Yoon H S, Kwon I H. Comparative study of balloon kyphoplasty with unilateral versus bilateral approach in osteoporotic vertebral compression fractures. Int Orthop 2007; September 3. Available at: http://www.springerlink.com/content/y4138584r2622305/ Accessed April 4, 2008
  • 44 Wong W, Mathis J. Is intraosseous venography a significant safety measure in performance of vertebroplasty?.  J Vasc Interv Radiol. 2002;  13 137-138
  • 45 Gaughen Jr J R, Jensen M E, Schweikert P A et al.. Relevance of antecedent venography in percutaneous vertebroplasty for the treatment of osteoporotic compression fractures.  AJNR Am J Neuroradiol. 2002;  23 594-600
  • 46 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
  • 47 Belkoff S M, Molloy S. Temperature measurement during polymerization of polymethylmethacrylate cement used for vertebroplasty.  Spine. 2003;  28 1555-1559
  • 48 Gill J B, Kuper M, Chin P C, Zhang Y, Schutt R. Comparing pain reduction following kyphoplasty and vertebroplasty for osteoporotic vertebral compression fractures.  Pain Physician. 2007;  10 583-590
  • 49 Hulme P A, Krebs J, Ferguson S J, Berlemann U. Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies.  Spine. 2006;  31 1983-2001
  • 50 Taylor R S, Fritzell P, Taylor R J. Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis.  Eur Spine J. 2007;  16 1085-1100
  • 51 Diamond T H, Champion B, Clark W A. Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy.  Am J Med. 2003;  114 257-265
  • 52 Voormolen M H, Mali W P, Lohle P N et al.. Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS Study.  AJNR Am J Neuroradiol. 2007;  28 555-560
  • 53 Theodorou D J, Theodorou S J, Duncan T D, Garfin S R, Wong W H. Percutaneous balloon kyphoplasty for the correction of spinal deformity in painful vertebral body compression fractures.  Clin Imaging. 2002;  26 1-5
  • 54 Mathis J M, Ortiz O, Zoarski G H. Vertebroplasty versus kyphoplasty: a comparison and contrast.  AJNR Am J Neuroradiol. 2004;  25 840-845
  • 55 Teng M M, Wei C J, Wei L C et al.. Kyphosis correction and height restoration effects of percutaneous vertebroplasty.  AJNR Am J Neuroradiol. 2003;  24 1893-1900
  • 56 Pradhan B B, Bae H W, Kropf M A, Patel V V, Delamarter R B. Kyphoplasty reduction of osteoporotic vertebral compression fractures: correction of local kyphosis versus overall sagittal alignment.  Spine. 2006;  31 435-441
  • 57 Lin W C, Cheng T T, Lee Y C, Wang T N et al.. New vertebral osteoporotic compression fractures after percutaneous vertebroplasty: retrospective analysis of risk factors.  J Vasc Interv Radiol. 2008;  19 225-231
  • 58 Duran C, Sirvanci M, Aydoğan M, Ozturk E, Ozturk C, Akman C. Pulmonary cement embolism: a complication of percutaneous vertebroplasty.  Acta Radiol. 2007;  48 854-859
  • 59 Abdul-Jalil Y, Bartels J, Alberti O, Becker R. Delayed presentation of pulmonary polymethylmethacrylate emboli after percutaneous vertebroplasty.  Spine. 2007;  32 E589-E593
  • 60 Scroop R, Eskridge J, Britz G W. Paradoxical cerebral arterial embolization of cement during intraoperative vertebroplasty: case report.  AJNR Am J Neuroradiol. 2002;  23 868-870
  • 61 Chung S E, Lee S H, Kim T H, Yoo K H, Jo B J. Renal cement embolism during percutaneous vertebroplasty.  Eur Spine J. 2006;  15(suppl 5) S590-S594
  • 62 Kim S Y, Seo J B, Do K H, Lee J S, Song K S, Lim T H. Cardiac perforation caused by acrylic cement: a rare complication of percutaneous vertebroplasty.  AJR Am J Roentgenol. 2005;  185 1245-1247
  • 63 Son K H, Chung J H, Sun K, Son H S. Cardiac perforation and tricuspid regurgitation as a complication of percutaneous vertebroplasty.  Eur J Cardiothorac Surg. 2008;  33 508-509
  • 64 Lin E P, Ekholm S, Hiwatashi A, Westesson P L. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body.  AJNR Am J Neuroradiol. 2004;  25 175-180
  • 65 Lazáry Á, Speer G, Varga P P et al.. Effect of vertebroplasty filler materials on viability and gene expression of human nucleus pulposus cells.  J Orthop Res. 2008;  26 601-607
  • 66 Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty.  Rheumatology. 2000;  39 1410-1414
  • 67 Delmas P D, Genant H K, Crans G G et al.. Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial.  Bone. 2003;  33 522-532
  • 68 Uppin A A, Hirsch J A, Centenera L V, Pfiefer B A, Pazianos A G, Choi I S. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis.  Radiology. 2003;  226 119-124
  • 69 Fribourg D, Tang C, Sra P, Delamarter R, Bae H. Incidence of subsequent vertebral fracture after kyphoplasty.  Spine. 2004;  29 2270-2276
  • 70 Harrop J S, Prpa B, Reinhardt M K, Lieberman I. Primary and secondary osteoporosis' incidence of subsequent vertebral compression fractures after kyphoplasty.  Spine. 2004;  29 2120-2125
  • 71 Pflugmacher R, Schroeder R J, Klostermann C K. Incidence of adjacent vertebral fractures in patients treated with balloon kyphoplasty: two years' prospective follow-up.  Acta Radiol. 2006;  47 830-840
  • 72 Moon E S, Kim H S, Park J O et al.. The incidence of new vertebral compression fractures in women after kyphoplasty and factors involved.  Yonsei Med J. 2007;  48 645-652
  • 73 Kasperk C, Hillmeier J, Nöldge G et al.. Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study.  J Bone Miner Res. 2005;  20 604-612
  • 74 Cloft H J, Jensen M E. Kyphoplasty: an assessment of a new technology.  AJNR Am J Neuroradiol. 2007;  28 200-203
  • 75 National Institutes of Health ClinicalTrials.gov Database. KAVIAR study: kyphoplasty and vertebroplasty in the augmentation and restoration of vertebral body compression fractures. Available at: http://www.clinicaltrials.gov/ct2/show/NCT00323609?term=kyphoplasty&rank=1 Accessed April 4, 2008
  • 76 National Institutes of Health ClinicalTrials.gov Database. Cost effectiveness and efficacy of kyphoplasty and vertebroplasty trial. Available at: http://www.clinicaltrials.gov/ct2/show/NCT00279877?term=kyphoplasty&rank=4 Accessed April 4, 2008

Kimi L KondoD.O. 

Department of Radiology, University of Colorado Denver, Leprino Building

Room 537, 12401 East 17th Avenue, Mail Stop L954, Aurora, CO 80045

Email: Kimi.Kondo@ucdenver.edu

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