Vertebral augmentation is a category of surgeries used to treat vertebral compression fractures (VCFs). Vertebral compression fractures are the most common type of fracture in patients with osteoporosis and osteopenia; about 750,000 people annually are affected.1

Goals of vertebral augmentation surgery include some combination of the following:

  • Pain reduction
  • Vertebra stabilization
  • Vertebral height restoration (for some types of fractures and procedures)
  • Deformity (e.g. kyphosis) reduction (for some types of fractures and procedures)

Currently available approaches include vertebroplasty, balloon kyphoplasty, and radiofrequency vertebral augmentation.

All of the above procedures involve injecting bone cement into the inside of the fractured vertebra in order to create an "internal cast" inside the bone, with the goal of immediately stabilizing the fracture and reducing the patient's pain.

Vertebral augmentation surgeries

The main surgical approaches currently available include:

    Vertebroplasty
    Vertebroplasty involves injecting bone cement directly into a fractured vertebral body using a needle cannula in order to directly surround and connect the fracture fragments and create a type of internal cast to stabilize the fracture.

    This procedure is designed to use higher pressure to inject the cement, as well as a thin, low viscosity type of cement, in order to permeate around the many fracture fragments and lines, to create the internal cast within the bone. The cement spreads out throughout the fractured vertebra.

    Balloon Kyphoplasty
    This type of vertebral cement augmentation is designed to create a stabilizing cast on the inside of the fractured bone and reduce pain. Another common goal of the procedure is to reduce the deformity of the bone, which is typically called excessive kyphosis, or a stooped forward position of the spine, as well as to restore the original height of the vertebra.

    In balloon kyphoplasty, a cannula - or tube - is used to create an entry into the fractured bone. A balloon is then inserted through the tube into the damaged vertebral body. Once inside the vertebra, the balloon is inflated to create an open space inside of the bone that can be filled with bone cement. Inflating the balloon helps to compress the fracture fragments together at the periphery as the cavity is created. The cement injected is typically more viscous (thicker) than in vertebroplasty, and it is injected under lower pressure. As a result, most of the injected cement stays within the cavity with mild permeation into the fragments at the periphery. This procedure is felt by many to have less risk of cement leakage into the vascular structures or spinal canal, which can create serious complications.

    In addition to balloon kyphoplasty, several other forms of kyphoplasty are now available that are similar procedures but do not use a balloon.

    Radiofrequency-targeted Vertebral Augmentation (RF-TVA)
    In addition to vertebroplasty and balloon kyphoplasty, other vertebral augmentation procedures have been introduced in recent years. For example, RF-TVA is a type of kyphoplasty because it involves first creating a cavity in the fractured vertebral bone, but does not use a balloon to do so.

    The goals of the RF-TVA procedure include slowly filling the cavity with a controlled delivery of bone cement, with the theory that this allows the bone cement to penetrate the small cracks and to avoid potential leakage of the bone cement outside of the fractured bone.

There are a number of other vertebral augmentation systems currently in development.

All vertebral augmentation procedures are considered minimally invasive surgeries. The patient will typically go home the same day as the procedure, or sometimes after one night in the hospital.

These are, however, commonly performed procedures with generally high success rates in terms of improving the patient's pain and stabilizing the fracture. Because they are minimally invasive procedures, the risks are relatively low compared to more aggressive and larger open spinal fusion surgery.

As with all surgical procedures, there are potential risks and complications involved with any type of vertebral augmentation procedures. Vertebral augmentation is an elective surgery, so patients are advised to talk with their surgeon and independently research the risks along with potential benefits before deciding whether or not to have a procedure.

References:

  1. Vertebral Compression Fractures. American Association of Neurological Surgeons. Available at http://www.aans.org/patient%20information/conditions%20and%20treatments/vertebral%20compression%20fractures.aspx. Accessed Decemeber 2014.
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