Vertebral Augmentation for Compression Fractures

Vertebral augmentation is a category of surgical procedures that are used to stabilize a fractured vertebra with the goal of reducing the patient's pain. These procedures are termed vertebroplasty, kyphoplasty, or radiofrequency vertebral augmentation.

Most people who undergo some type of vertebral augmentation have suffered a fracture in a spinal vertebra called a compression fracture. A compression fracture is usually caused by relatively minor trauma in patients with osteoporosis, a disease that leaves spinal vertebrae weak and brittle and prone to fracture. Fractures can also be caused by a spinal infection or tumor, or from more significant trauma to the spine.

All vertebral augmentation procedures are minimally invasive surgeries. Typically, the patient goes home the same day as the procedure, or sometimes after an overnight hospital stay. All of the procedures involve injecting bone cement into the inside of the fractured vertebra in order to create an "internal cast" inside the bone, with the goals of stabilizing the fracture and reducing the patient's pain.

Approaches to Vertebral Augmentation

The main vertebral augmentation approaches currently available include:

    Vertebroplasty is a procedure in which bone cement is injected directly into a fractured vertebral body in order to create a type of internal cast to stabilize the fractured bone. Vertebroplasty was introduced in the US in the early 1990s.

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    Balloon kyphoplasty
    Similar to vertebroplasty, kyphoplasty is a procedure that is designed to create an internal cast inside of the fractured bone in order to stabilize it. In addition, this procedure is designed with the goal of reducing the deformity of the bone (usually in the form of an outward curve of the thoracic spine known as kyphosis) and restoring vertebral height. Another difference is that with balloon kyphoplasty, a thicker (more viscous) cement is introduced into the bone using larger injection cannulas and less pressure.

    In balloon kyphoplasty, a balloon is first inserted into the damaged vertebral body. Once inside the damaged vertebra, the balloon is then inflated to create a cavity within the bone that can be filled with bone cement. The cavity created contains most of the injected cement, and the balloon helps to compress the fracture fragments together as the cavity is created.

    Balloon kyphoplasty was introduced in the US in the late 1990s.

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    Other types of vertebral augmentation
    In addition to vertebroplasty and balloon kyphoplasty, other vertebral augmentation procedures have been introduced in recent years. An example is radiofrequency-targeted vertebral augmentation (RF-TVA). This approach 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.

Considerations for Vertebral Augmentation

In general, there is a lack of clear consensus or guidelines about which procedure should be considered for which types of cases or fractures, when the procedure should be done, and the relative merits and risks of each procedure.

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 for pain relief involved with these procedures.

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