Minimally Invasive Treatment of Painful Osteoporotic Vertebral Fractures

Article information

J Korean Med Assoc. 2009;52(4):382-392
Publication date (electronic) : 2009 April 30
doi :
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Korea.,


The consequences of osteoporotic vertebral compression fractures are pain, progressive vertebral collapse with resultant kyphosis, and systemic manifestations. Minimally invasive stabilization procedures such as vertebroplasty and balloon kyphoplasty have been introduced to treat for refractory pain due to these fractures. Vertebroplasty and kyphoplasty are new alternatives for the treatment of osteoporotic vertebral compression fractures. Both methods stabilize the fractured vertebra with polymethylmethacrylate cement to relieve pain and allow immediate mobilization. Kyphoplasty is an extension of vertebroplasty that uses an inflatable bone tamp to restore the vertebral body height while creating a cavity to be filled with bone cement. A large proportion of subjects had some pain relief both in vertebroplasty and kyphoplasty. Vertebral height restoration was possible using kyphoplasty and for a subset of patients using vertebroplasty. Cement leaks occurred in both groups but, the incidence of cement leakage in kyphoplasty is lower than that of the vertebroplasty. Vertebroplasty and kyphoplasty are safe and effective procedures. Good short-term results have been reported following both vertebroplasty and kyphoplasty for the painful osteoporotic vertebral fractures. Severe complications result from bone cement leakage into the spinal canal or the vascular system have been reported but the incidence was very rare. Both vertebroplasty and kyphoplasty offer therapeutic benefit significantly reducing pain and improving mobility in patients with vertebral fracture without significant differences between groups in term of quality. While early results are promising, more research is needed to better understand the log-term effects of both procedures on the human spine.


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Figure 1

Anteroposterior view of the C-arm during the vertebroplasty. The tips of the J-type biopsy needles are located on the lateral aspect of pedicles.

Figure 2

Lateral view of the C-arm during the vertebroplasty. The tips of the J-type biopsy needles are located on the anterior aspect of the vertebral body.

Figure 3

After placing the cannula over the blunt dissector and advance it just beyond the pedicle, place a drill bit down the cannula using manual control, twist the drill bit to enter the vertebral body. The final position is just posterior to the anterior cortex.

Figure 4

Insert the inflatable bone tamps through the same cannula.

Figure 5

The inflatable bone tamps are prepared with contrast medium to facilitate imaging during inflation. The balloons are inflated using a manometer with digital pressure gauges. Alternative slow filling of the balloons by raising the pressure to 150 psi.

Figure 6

When ready to fill the PMMA, one or both inflatable bone tamps are deflated, and using lateral C-arm guidance, cement cannulas are inserted through the working cannulas to the anterior wall of the vertebral body. Confirm placement on anteroposterior and lateral images. The cement cannula sytlets are used to gently push the selected viscous bone filler from the cement cannula while the cement cannulas are withdrawn to the level of the middle of the cavity.

Figure 7

Transpedicular approach. The entry point is the bone at the junction of the pedicle and posterior vertebral body on the lateral X-ray film.

Figure 8

Extrapedicular approach. In thoracic vertebral bodies with small pedicles or in midthoracic vertebral bodies a transpedicular approach will result in lateral balloon placement. The entry point is immediately superior and slightly lateral to the pedicle, just medial to the rib head. This may involve actually cannulating the rib head and entering the vertebral body through the rib facet on the posterosuperolateral corner of the vertebral body.