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Osteosynthesis and Trauma Care 2003; 11(4): 206-211
DOI: 10.1055/s-2003-820524
Original Article

© Georg Thieme Verlag Stuttgart · New York

Indication and Performance of Kyphoplasty for Vertebral Fractures

B. M. Boszczyk1 , M. Bierschneider1 , M. Potulski2 , R. Beisse2 , H. Jaksche1
  • 1Department of Neurosurgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
  • 2Department of Trauma Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
Further Information

Publication History

Publication Date:
23 February 2004 (online)

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Abstract

Kyphoplasty is a new therapeutic approach that was developed for minimally invasive augmentation of osteoporotic vertebral fractures. In contrast to vertebroplasty, kyphoplasty enables age-dependent fracture reduction by means of pressure-controlled inflation of a balloon that is inserted transpedicularly into the cancellous bone of the fractured vertebral body. The cavity that remains after the balloon has been removed is filled with augmentation material for retention. The low rate of serious complications, such as intraspinal material leakage associated with this procedure, justifies attempts to expand its indication to specific types of traumatic fractures and neoplastic vertebral collapse due to osteolytic metastases. Along with indications for conventional percutaneous access, the “semi-open” microsurgical approach also enables kyphoplasty to be applied to treat more complex vertebral body fractures that are accompanied by compression of neural structures. The surgical procedures used in kyphoplasty quickly reduce pain and enable patients to be quickly mobilised by means of stabilising the affected vertebral body immediately. Interdisciplinary treatment must nonetheless be continued after kyphoplasty, in order to optimise individual medical treatment and rehabilitation regarding the underlying disease.

Key words

Osteoporosis - minimally invasive surgery - vertebral fracture - kyphoplasty

References

  • 1 Berlemann U, Heini P F. Perkutane Zementierungstechniken zur Behandlung osteoporotischer Wirbelkörpersinterungen.  Unfallchirurg. 2002;  105 2-8
    CrossrefPubMedGoogle Scholar
  • 2 Berlemann U, Ferguson S J, Nolte L P, Heini P F. Adjacent vertebral failure after vertebroplasty.  J Bone Joint Surg [Br]. 2002;  84 748-752
    CrossrefPubMedGoogle Scholar
  • 3 Bernhard J, Heini P F, Villiger P M. Asymptomatic diffuse pulmonary embolism caused by acrylic cement: an unusual complication of percutaneous vertebroplasty.  Ann Rheum Dis. 2003;  62 85-86
    CrossrefPubMedGoogle Scholar
  • 4 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
    CrossrefPubMedGoogle Scholar
  • 5 Boszczyk B M, Bierschneider M, Robert B, Jaksche H. Treatment of severe osteoporotic fractures through a microsurgical interlaminary approach. In: Szpalski M, Gunzburg R (Eds). Vertebral osteoporotic compression fractures. Lippincott WW, Philadelphia 2003; 179-188
    Google Scholar
  • 6 Boszczyk B M, Bierschneider M, Robert B, Jaksche H. Augmentationstechniken an der Wirbelsäule - Aktueller Stand der Techniken und der therapeutischen Möglichkeiten.  Orthopädie & Rheuma. 2002;  1 19-26
    PubMedGoogle Scholar
  • 7 Boszczyk B, Bierschneider M, Potulski M, Robert B, Vastmans J, Jaksche H. Erweitertes Anwendungsspektrum der Kyphoplastie zur Stabilisierung der osteoporotischen Wirbelfraktur.  Unfallchirurg. 2002;  105 952-957
    Google Scholar
  • 8 Boszczyk B M, Bierschneider M, Schmid K, Robert B, Jaksche H. Kyphoplastik im konventionellen und halboffenen Verfahren.  Orthopäde. (in press).
    PubMedGoogle Scholar
  • 9 Chen H L, Wong C S, Ho S T, Chang F L, Hsu C H, Wu C T. A lethal pulmonary embolism during percutaneous vertebroplasty.  Anesth Analg. 2002;  95 1060-1062
    PubMedGoogle Scholar
  • 10 Davis J W, Grove J S, Wasnich R D, Ross P D. Spatial relationships between prevalent and incident spine fractures.  Bone. 1999;  24 261-264
    CrossrefPubMedGoogle Scholar
  • 11 Dudeney S, Lieberman I H, Reinhardt M K, Hussein M. Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma.  J Clin Oncol. 2002;  20 2382-2387
    Google Scholar
  • 12 Fourney D R, Schomer D F, Nader R, Chlan-Fourney J, Suki D, Ahrar K, Rhines L D, Gokaslan Z L. Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients.  J Neurosurg (Spine). 2003;  98 21-30
    Google Scholar
  • 13 Garfin S R, Hansen A Y, Reiley M A. Kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures.  Spine. 2001;  26 1511-1515
    Google Scholar
  • 14 Garfin S R, Lin G, Lieberman I, Phillips F, Truumees E. Retrospective analysis of the outcomes of balloon kyphoplasty to treat vertebral body compression fracture refractory to medical management (Abstract).  Eur Spine J. 2001;  10 S 7-S 8
    PubMedGoogle Scholar
  • 15 Harrington K D. Major neurological complications following percutaneous vertebroplasty with polymethylmethacrylate.  J Bone Joint Surg [Am]. 2001;  84 1070-1073
    PubMedGoogle Scholar
  • 16 Heini P F, Berlemann U. Bone substitutes in vertebroplasty.  Eur Spine J. 2001;  10 S 205-S 213
    PubMedGoogle Scholar
  • 17 Jang J S, Lee S H, Jung S K. Pulmonary embolism of polymethylmethacrylate after percutaneous vertebroplasty.  Spine. 2002;  27 E 416-E 418
    PubMedGoogle Scholar
  • 18 Ledlie J T, Renfro M. Balloon kyphoplasty: One-year outcomes in vertebral body height restoration, chronic pain and activity levels.  J Neurosurg (Spine). 2003;  98 36-42
    Google Scholar
  • 19 Lee B J, Lee S R, Yoo T Y. Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate.  Spine. 2002;  27 E 419-E 422
    PubMedGoogle Scholar
  • 20 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 1631-1638
    CrossrefPubMedGoogle Scholar
  • 21 Magerl F, Aebi M, Gertzbein S D, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries.  Eur Spine J. 1994;  3 184-201
    Google Scholar
  • 22 Oner F C, van der Rijt R R, Ramos L MP, Dhert W JA, Verbout A J. Changes in the disc space after fractures of the thoracolumbar spine.  J Bone Joint Surg [Br]. 1998;  80 833-839
    PubMedGoogle Scholar
  • 23 Oner F C, van Gils A PG, Faber A J, Dhert W JA, Verbout A J. Some complications of common treatment schemes of thoracolumbar spine fractures can be predicted with magnetic resonance imaging.  Spine. 2002;  27 629-636
    CrossrefPubMedGoogle Scholar
  • 24 Perez-Higueras A, Alvarez L, Rossi R E, Quinones D, Al-Assir I. Percutaneous vertebroplasty: long-term clinical and radiological outcome.  Neuroradiology. 2002;  44 950-954
    Google Scholar
  • 25 Padovani B, Kasriel O, Brunner P, Peretti-Viton P. Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty.  Am J Neuroradiol. 1999;  20 375-377
    PubMedGoogle Scholar
  • 26 Ratliff J, Nguyen T, Heiss J. Root and spinal cord compression from methylmethacrylate vertebroplasty.  Spine. 2001;  26 E 300-E 302
    PubMedGoogle Scholar
  • 27 Ross P D, Genant H K, Davis J W, Miller P D, Wasnich R D. Predicting vertebral fracture incidence from prevalent fractures and bone density among none-black, osteoporotic women.  Osteoporosis Int. 1993;  3 120-126
    CrossrefPubMedGoogle Scholar
  • 28 Scroop R, Eskridge J, Britz G W. Paradoxical cerebral embolization of cement during intraoperative vertebroplasty: case report.  Am J Neuroradiol. 2002;  23 868-870
    PubMedGoogle Scholar
  • 29 Tozzi P, Abdelmoumene Y, Corno A F, Gersbach P A, Hoogewoud H M, von Segesser L K. Management of pulmonary embolism during acrylic vertebroplasty.  Ann Thorac Surg. 2002;  74 1706-1708
    CrossrefPubMedGoogle Scholar
  • 30 Wenger W, Markwalder T M. Surgically controlled, transpedicular methyl methacrylate vertebroplasty with fluoroscopic guidance.  Acta Neurochir. 1999;  141 625-631
    CrossrefPubMedGoogle Scholar
  • 31 Wilke H J, Mehnert U, Boszczyk B, Bierschneider M, Jaksche H, Claes L E. Biomechanical evaluation of vertebro- and kyphoplasty under cyclic loading. (Abstract) - presented at: The Aging Spine - Swiss Spine Society Basel 2002.  Eur Spine J. 2002;  11 613
    PubMedGoogle Scholar
  • 32 Wilson D R, Myers E R, Mathis J M, Scribner R M, Conta J A, Reiley M A, Talmadge K D, Hayes W C. Effect of augmentation on the mechanics of vertebral wedge fractures.  Spine. 2002;  25 158-165
    PubMedGoogle Scholar
  • 33 Wong W, Reiley M, Garfin S. Vertebroplasty/kyphoplasty.  J Women's Imaging. 2000;  2 117-124
    PubMedGoogle Scholar

Dr. B. M. Boszczyk

Berufsgenossenschaftliche Unfallklinik Murnau

Prof.-Küntscher-Str. 8

82418 Murnau

Germany

Phone: +49/88 41-48-28 51

Fax: +49/88 41-48-28 54

Email: B.Boszczyk@gmx.net

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