Operative Management

Two percutaneous treatment options for painful vertebral compression fractures—vertebroplasty and kyphoplasty—involve the injection of polymethyl methacrylate (PMMA) into a compressed vertebral body. Studies show that the procedures may restore vertebral height especially if performed within 6 to 12 weeks of the fracture and relieve pain. Kyphoplasty employs a balloon tamp to create a cavity into which the PMMA is injected. Compared with vertebroplasty, which does not utilize a balloon, kyphoplasty allows for greater fill of the vertebral body and height restoration with lower risk of PMMA extravasation. The mechanism of pain relief is not proven, but micromotion of fractured vertebral bodies may be a source of pain and is reduced after the procedure. Complications include PMMA extravasation (up to 30% with vertebroplasty and 10% with kyphoplasty), which can result in neurologic sequelae, embolization to the vertebral venous plexus and to distant sites, and possibly adjacent vertebral fractures. These procedures appear to be most effective if performed soon after fracture. One study that compared vertebroplasty and kyphoplasty showed little difference between the two procedures and recommended vertebroplasty based on the higher cost of kyphoplasty.