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Percutaneous Treatment of Vertebral Body Pathology

Dr. Spivak is Director, The Hospital for Joint Diseases Spine Center, New York, NY. Dr. Johnson is Assistant Professor, Orthopaedics and Neurosurgery, University of Manitoba, Manitoba, Winnipeg, Canada.

Reprint requests: Dr. Spivak, The Hospital for Joint Diseases Spine Center, 301 East 17th Street, New York, NY 10003.

Percutaneous vertebral body injection procedures currently are used to stabilize and reinforce weakened or fractured bone resulting from metastatic disease and severe osteoporosis. Both vertebroplasty and kyphoplasty can reinforce the structure of a vertebral body and provide pain relief, but the procedures have technical differences. Kyphoplasty improves vertebral height to varying degrees in nearly three quarters of patients. Kyphosis is improved more effectively when the procedure is performed within 3 months from the onset of fracture pain. To date, it is unknown whether vertebroplasty with preprocedure postural reduction can provide similar improvement of deformity. Complications are relatively infrequent with both vertebroplasty and kyphoplasty. Cement leakage from the vertebral body is more likely with vertebroplasty than with kyphoplasty. Leakage is more common in the treatment of pathologic fractures resulting from metastatic disease. Clinical complications caused by cement leakage and neural compression are infrequent. Specific indications for these injection procedures need to be more clearly refined. Long-term outcomes, including the fate of the injected material and the effect on adjacent vertebrae, have yet to be determined.

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