Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty

Vertebral fracture is the most common complication of osteoporosis. It resu lts in significant mortality and morbidity, including prolonged and intract able pain in a minority of patients. Vertebroplasty and kyphoplasty, proced ures that involve percutaneous injection of bone cement into a collapsed ve rtebra, have recently been introduced for treatment of osteoporotic patient s who have prolonged pain (several weeks or longer) following vertebral fra cture. To determine the details of the procedures and to gather information on their safety and efficacy, we performed a MEDLINE search using the term s 'vertebroplasty' and 'kyphoplasty. We reviewed reports of these procedure s in patients with osteoporosis. We supplemented the articles found with ot her papers known to the authors and with presentations at national meetings . Randomized trials of vertebroplasty and kyphoplasty have not been reporte d. Case reports suggest that these procedures are associated with pain reli ef in 67% to 100% of cases. Short-term complications, mainly the result of extravasation of cement, include increased pain and damage from heat or pre ssure to the spinal cord or nerve roots. Proper patient selection and good technique should minimize complications, but rarely, decompressive surgery is needed. Longterm benefits have not yet been shown, but potentially inclu de prevention of recurrent pain at the treated level(s) with both procedure s, and, with kyphoplasty, reversal of height loss and spinal deformity, an improved level of function, and avoidance of chronic pain and restriction o f internal organs. Possible long-term complications, again not fully evalua ted, include local acceleration of bone resorption caused by the treatment itself or by foreign-body reaction at the cement-bone interface, and increa sed risk of fracture in treated or adjacent vertebrae through changes in me chanical forces. Controlled trials are needed to determine both short-term and long-term safety and efficacy of vertebroplasty and kyphoplasty. Both p rocedures may be useful for osteoporotic patients who have prolonged pain f ollowing acute vertebral fracture. Until there is conclusive evidence for e fficacy and long-term safety, these procedures should be done only in caref ully selected patients, only by experienced operators with appropriate high -quality imaging equipment, and ideally at centers that are participating i n controlled trials.