Vertebroplasty and kyphoplasty: friends or foes?

This paper aims to compare vertebroplasty and kyphoplasty by illustrating the two techniques, analysing the results and discussing the indications in relation to the type of fracture.

Vertebroplasty was performed on 805 vertebral bodies in 485 patients affected by osteoporosis (310), metastasis (160) and vertebral haemangioma (15). The approach was unipedicular in 365 patients and bipedicular in 120 patients. Biopsies were obtained in patients with no known primary cancer (75). Kyphoplasty was performed in 39 patients with Magerl type A1 and A3 fractures within 3 months from the trauma. A bipedicular approach was used in all cases.

Outcomes were assessed on the basis of the visual analogue scale and the Oswestry Disability Index. In patients treated with vertebroplasty, success rates at 24-72 h were 90% for osteoporotic fractures, 100% for vertebral haemangiomas and 77% for metastatic fractures. Extravertebral vascular or discal leakage of cement occurred in 39 patients, but only two of them reported radicular pain due to epidural involvement. Osteoporotic patients developed new vertebral fractures at adjacent levels in 25 cases and at distal levels in 19 cases. In patients treated with kyphoplasty, pain relief was achieved within one month after treatment in 90% of cases. None of the patients wore orthotic braces after treatment, and no vertebral collapse was observed.

Vertebroplasty and kyphoplasty are both useful in the management of vertebral pain. In light of our experience, vertebroplasty is better indicated for vertebral fractures due to osteoporosis, haemangioma or metastasis on account of its simplicity and minimal invasiveness. Kyphoplasty is suggested in acute traumatic fractures of type A1 and A3 according to Magerl, as it allows recovery of vertebral stability and a better distribution of the cement.