1. Extended Indications for Balloon Kyphoplasty – use of the curette to treat Vertebra Plana
John Dabis,
Hani Abdul-Jabar, Matt Smith and Michael Kotrba
Croydon University Hospital Spinal Unit
BASS, Norwich 2013

2. AIM
Describe a surgical technique to restore anterior, middle and posterior vertebral body height in vertebra plana
Does vertebra plana correction lead to improved kyphotic angles? And does this lead to better outcomes?

3. Methods Retrospective review
Between – 148 procedures (single - multi-level)
Calculated kyphotic angles
Short term outcomes SF-36 and VAS
Inclusion criteria
All vertebra plana fractures

4. Calculation of Kyphotic angle

5. Kyphotic angle and Outcome summary
Pre op angle
Pre op
VAS
Post op
angle
Post op VAS
12 month SF36
Patient A 29 7 4 3 82
Patient B 34 9 12 2 88
Patient C 38 10 6 5 *
Patient D 26 8
4.5
Patient E
Patient F 31 90
Patient G 27
11.5
Patient H 68
Patient I 75
Patient J 35

6. Surgical Technique

13. Discussion Kyphoplasty: indications, contraindications and technique
Masala S, Fiori R, Massari F, Simonetti G.
Radiol Med. 2005
The main contraindications are coagulation disorders, unstable fractures or complete vertebral collapse (vertebra plana).

14. Evidence
Balloon kyphoplasty for vertebra plana with or without osteonecrosis
S Becker, A Tuschel, A Chavanne, J Meissner, M Ogon
Journal of Orthopaedic Surgery 2008
Preliminary results with modified techniques of balloon kyphoplasty for vertebra plana, traumatic fractures and neoplasms
Becker S, Meissner J, Bartl R, Bretschneider W, Ogon M
Acta Orthop Belg. 2006

15. Conclusion
Vertebra plana is not a contraindication to balloon kyphoplasty
The use of the curette is critical in determining the direction of the balloon tamp passage