Vertebroplasty and kyphoplasty

Medically intractable pain from Vertebral compression fracture due to osteoporosis
Myeloma with intractable pain and no neurology
Metastases with intractable pain and no neurology
Vertebral angioma with intractable pain and no neurology

Under intravenous sedation with local anaesthetic or general anaesthesia.
The patient is placed prone with bi- planar fluoroscopy or under CT guidance, a unilateral or bilateral approach via a small stab incision is made.
An 11– 13- gauge needle is passed to the anterior third or quarter of the vertebral body via a transpedicular or parapedicular route (the point of attachment of the pedicle to the vertebral body).
Polymethyl methacrylate cement is then slowly injected until it approaches the posterior vertebral wall. If extraosseous cement is noted the procedure should be terminated immediately.

Cement is made from methymethacrylate;
an exothermic reaction when the cement is mixed is thought to provide some of the analgesic benefits.

Radicular pain
Neurological complications
Adjacent level fractures
Worsening of or failure to relieve pain
Failure to successfully inject cement (e.g. due to severely collapsed vertebra)
Pedicle fracture
pulmonary embolism (spinal canal, nerve root canal, vascular tissue, intervertebral disc)

Penetrating trauma due to needle malplacement (vascular injury, pneumothorax, rib fracture etc.)

Same except the needle is passed under the endplate at the centre of the vertebral body and a series of tools are used to create a working channel down which a bone tamp is passed.
The tamp is expanded under fluoroscopic guidance with volume and pressure monitoring.
Inflation is stopped when the height is restored or maximal volume/ pressure is achieved in the balloon or the balloon comes within 1 mm of the cortical surface.
The tamp is removed and Polymethyl methacrylate cement is then slowly injected into the cavity.

Typical short- and long- term outcome measures for these procedures are pain scores (VAS), disability scores (ODI), complications (cement leakage, neurological injury), height of anterior vertebral body, kyphotic angle, adjacent level fractures, and length of stay.

There was no difference noted in the incidence of adjacent level fracture between kyphoplasty and vertebroplasty.

Both of these interventions reduced the incidence compared to conservative treatment.

Kyphoplasty may have a slight advantage over vertebroplasty in restoration of the anterior vertebral height and kyphotic angle