1. Kyphoplasty for the Treatment of Vertebral Compression Fractures
Jessica Brock
Advised by Sam Powdrill

2. Vertebral Compression Fractures
The most common complication of osteoporosis
Estimated 700,000 VCFs occur annually
200,000 are refractory to medical management
Cost $10-15 billion annually
Can result in spinal deformity: kyphosis/lordosis
Cause acute and chronic pain leading to disability
Cause of reduced vital capacity

3. The Downward Spiral Osteoporosis VCFs Spinal Deformity
Decreased lung capacity
Decreased physical function
Early Satiety
Sleep problems
Decreased activity
More bone loss
Increased fracture risk
Decreased pulmonary function
Increased mortality

4. Prevention
Bone Density Testing in women > 65 year, men > 70 years
Adequate intake of calcium, vitamin D, and regular weight bearing exercise
Pharmacology: bisphosphonates, calcitonin, SERMS
Reduce the risk of falling
Identify bone health and risk for fracture
Bisphosphonates and calcitonin both decrease osteoclastic activity. Selective estrogen receptor modulators increase bone density and reduce fracture risk.
Assess pt’s fxnal status, eliminate fall risk in the environment, review medications that affect the individual.

5. Signs and Symptoms
Consider VCF in any patient > 50 years if they complain of acute or chronic back pain
Get a AP and lateral x-ray of the spine
Look for wedge shaped vertebral bodies
MRI with T2 sequence shows state of fracture healing

7. Conservative Therapy NSAIDS Opiods Muscle relaxants Bed rest
Orthotic bracing
VCF healing should occur in 6-12 weeks
Refractory in 15-20% of patients
Worry about the consequences of immobility for that time, and that medications could make falling/osteo worse.

8. Kyphoplasty Minimally-invasive Percutaneous
Can restore lost vertebral height
Immediate pain reduction
Fewer complications compared to vertebroplasty
By 2005, performed on 170,000 patients

9. Kyphoplasty 2 fluoroscopy units for visualization
Patient is supported in prone position
4 cm bilateral incision via the pedicles using trocar, guidewire, cannula, bone tamp, cement
Maximum of 3 vertebral bodies

11. Fig. 1 Sixty-two year-old female
Fig. 1 Sixty-two year-old female. a Preoperative sagittal T2-weight image shows gas filled fracture cleft in L2 vertebra. b Postoperative lateral
radiograph shows considerable increase in anterior vertebral height. c Radiograph 16 months after procedure shows refracture
of the cemented vertebra with focal kyphosis

12. Complications Cement Extravasation Adjacent VCFs post surgery—20-30%
Pulmonary embolism
Abscesses
Disc damage
Adjacent VCFs post surgery—20-30%
General complication rate 1-2%

13. Conclusions
Kyphoplasty is a safe and effective treatment for back pain due to osteoporotic VCFs.
Providers should include kyphoplasty in the discussion of options for the VCF patient
Reimbursement available by Medicare and private insurance companies

14. References
ACP medicine, Dale, D, and Federman, D. 3rd edition. WebMD Professional Publishing.
New York, NY , Vol. I,
Albertico, RA. Balloon Kyphoplasty for Multilevel Spinal Metastases from Breast
Cancer. J Support Oncol 2007;5:
Garfin, SR, Buckley, RA, and Ledlie, J. Balloon kyphoplasty for symptomatic vertebral
body compression fractures results in rapid, significant, and sustained
improvements in back pain, function, and quality of life for elderly patients.
Spine, (9), p
Hanna, J, and Letizia, M. A treatment for osteoporotic vertebral compression fractures.
Orthopedic Nursing. Vol 26(6) pg
Harrison, AL. Changes in the Bone Associated with Aging. Lecture at the University of
Kentucky. Summer 2007.
Howland, RD, and Mycek MJ. Pharmacology. 3rd edition. Lippincott Williams &
Wilkins. Philadelphia
Ledlie, JT and Renfro, MB. Kyphoplasty treatment of vertebral fractures: 2-year
outcomes show sustained benefits. Spine, (1): p.57-64
Pateder, DB, Khanna AJ, and Lieberman, IH. Vertebroplasty and Kyphoplasty for the
Management of Osteoporotic Vertebral Compression Fractures. Orthop Clin N
Am 38 (2007)
Robinson, Y., Tschoke, SK., Stahel, PF, Kayser, R., and Heyde, CE. Complications and
safety aspects of kyphoplasty for osteoporotic vertebral fractures: a prospective
follow-up study in 102 consecutive patients. Patient Safety in Surgery 2008, 2:2.
Surgeon General’s Report on Bone Health and Osteoporosis
Taylor, RS, Fritzell, P, and Taylor, RJ. Ballon kyphoplasty in the management of
vertebral compression fractures: an updated systematic review and meta-analysis.
Eur Spine J (2007) 16:
Vajnar, J. Compression Fractures in a Man with Osteoporosis. JAAPA Sept 2007, 20(9).
Resources:
National Osteoporosis Foundation
Kyphon, Inc. Sunnydale, CA