John M Mathis Wayne J Olan and Stephen M Belkoff

Pain relief after percutaneous vertebroplasty (PV) has been reported by 70 to 90% of patients with vertebral compression fractures (VCFs),1-4 but the deformity of the vertebral body or the subsequent kyphosis (usually related to multiple compressions) has not been addressed (for a more exhaustive treatment of vertebroplasty see Chapter 14).5 Bio-mechanically, kyphosis shifts the patient's center of gravity forward, rendering the patient off-balance and at increased risk for a fall. This change in a patient's center of gravity also creates additional stress on the vertebrae, increasing the risk of fracture.6 The kyphosis caused by VCFs in the lumbar or thoracic region decreases vital capacity in the lungs, which in turn accentuates restrictive lung disease.7 Leech et al.8 reported a 9% average decrease in forced vital capacity per osteoporotic compression fracture in the thoracic region. In addition, these fractures can lead to gastrointestinal difficulties. Increasing kyphosis may cause the ribs to increase pressure on the abdomen, creating a sensation of bloating that may lead to early satiety, decreased appetite, and mal-nutrition.9 There is a significant decrease in the life expectancy of patients with VCFs. In a retrospective study, Cooper et al.10 found that the 5-year survival rate for patients with VCFs was lower than that for patients with hip fractures. A prospective study by Kado et al.11 showed that patients with VCFs had a 23% higher mortality than age-matched controls. The increased mortality was thought to result from pulmonary causes, including pneumonia and chronic obstructive pulmonary disease.

Kyphoplasty (KP) was developed in an attempt to reduce the deformity of the vertebral body (Figure 18.1A) and subsequent kyphosis while providing pain relief similar to that of PV. Kyphoplasty consists of inserting a balloonlike device (referred to as a bone tamp) percuta-neously into a compressed vertebral body, inflating the device, and attempting to elevate the endplates and restore vertebral body height (Figure 18.1B). In theory, this procedure would be expected to improve vital lung capacity and gastrointestinal function by reducing the kyphosis associated with VCFs.12

T12 Superior Endplate Compression
Figure 18.1. (A) Osteoporotic compression fracture (T12) showing anterior and superior vertebral collapse (arrows) of about 50%. (B) Cadaver specimen with inflated kyphoplasty balloon (arrows).

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