Both kyphoplasty and vertebroplasty alter the structure of your vertebrae. This is to prevent further collapse in the bone and limit the risk of spinal deformities. These can occur when a VCF is left untreated.
What is a Vertebral Compression Fracture?
A vertebral compression fracture is characterized by a loss of height in one or multiple spinal bones due to a crushing of the bone, usually caused by osteoporosis or other bone density illnesses.
The spinal column itself is a rigid structure, grown to withstand years of pressure and provide ample support throughout our life. But different factors can weaken that column and erode the individual bones, or vertebrae, within it.
Because vertebrae aren’t uniformly dense, one part of them is more likely to crack or crush under pressure than another. In most cases, it’s the more fragile vertebral body that collapses first, rather than the lamina or the transverse and spinous processes (the bony protrusions of the spine).
If we imagine the spine as a tall building, with each vertebrae representing a floor, we can imagine what might happen if half of a floor is crushed. The entire top half of the building above it begins to lean severely into the direction of the crushed half. This is also what can happen in cases of VCF when a minor fracture becomes much more severe. The hunched back caused by advanced VCF is also known as kyphosis.
There are a few key reasons why vertebral compression fractures can occur, and most of them are not related to things like direct physical trauma or accidents. Most of the time, VCFs happen due to age and loss of bone density.
Because post-menopausal women are at a much higher risk of osteoporosis, they are also at a much higher risk of VCFs with advanced age. Factors contributing to the onset or exacerbation of a VCF include heavy smoking, diet, cancer, and obesity. Any factors that severely affect bone density or make bones more porous can increase the risk of a VCF.
So, how do these two procedures – kyphoplasty vs. vertebroplasty – treat VCFs? With bone cement.
Kyphoplasty vs. Vertebroplasty: Key Differences in Procedure
Both vertebroplasty and kyphoplasty involve injecting specialized bone cement into the affected vertebrae (vertebroplasty), stabilizing the bone, and preventing further cracking. The main difference between the two is that one involves injecting mixed bone cement into a cracked vertebra. The other starts by stabilizing a severe fracture and creating a space for the cement via a special medical device, usually a balloon (kyphoplasty).
While these minimally invasive procedures take little time to perform, they are still far from the first-line treatment for a suspected VCF. Vertebral compression fractures sound scary, but they don’t necessarily mean that your spine will certainly deform or collapse.
Only when a few other conservative treatment methods don’t help to address the problem, or when a doctor deems surgery to be the best and wisest course of treatment for an advancing VCF, will the option be on the table.
Many cases of VCF occur asymptomatically or without any severe signs of pain or discomfort. A person may lose a little height, but it could go unnoticed for a long time.
VCFs are mainly treated to address nerve pain caused by the fracture (usually radiculopathy or a pinched nerve) or to prevent spinal deformities that could lead to pain in the near future.
The inclusion of a balloon might not seem like a significant enough change to warrant two completely different procedures, but they are used for very different reasons.
Vertebroplasty is primarily used to reinforce the vertebra by filling out the fracture with safe bone cement. Vertebroplasty is usually performed on patients that have been sedated but remain awake.
Meanwhile, kyphoplasty can modify the spine by using the pressure and space created by the cement balloon to adjust a shifted spine, support a collapsing spine, or realign the spine. Kyphoplasty is usually performed with general anesthesia but can be performed with local anesthesia. Kyphoplasty vs. Vertebroplasty procedures are both highly successful and quite safe.
Choosing the Right Procedure
Your doctor will usually discuss your options with you if you have the choice between either procedure.
Most of the time, that choice is made for you – vertebroplasty is an effective way to stabilize a fracture without modifying the angle of the spine. At the same time, kyphoplasty would be recommended in cases where a spine is in danger of tilting forward or backward due to uneven crushing of the vertebra.
Other factors that may speed up the consideration for vertebroplasty or kyphoplasty include VCF-related pain at unbearable levels. This is in cases where pain medication has unacceptable side effects, serial wedging (worse with each visit), or acute severe wedging of the spine.
Complications and Risks
While both kyphoplasty and vertebroplasty are safe procedures, there are a few risks.
The most significant complication is cement leakage. The cement is usually a mixture of liquid and powder, specially made from polymethylmethacrylate (PMMA, sometimes known as Plexiglass), prepared before injection, and applied while still in a viscous state.
Once the cement hardens, it mimics the properties of bone. But until then, it can leak out of the vertebra or injection site. This risk is usually minimized by carefully guiding the injection via x-ray and keeping the patient still while the cement hardens.
If it does leak, it could harden outside the vertebra, applying pressure to the surrounding nerves and tissue. In rare cases, it could cause problems in other parts of the body. If you have concerns or questions, it’s important to bring these up with your doctor before considering surgery.
The treatment of pain after a vertebral fracture may entail more than just surgery. Long-term pain management can include strengthening exercises for the back, weight loss to reduce pressure on the spine, and opioid or non-opioid pain medication to help mitigate symptoms. If you still have questions about kyphoplasty vs. vertebroplasty, make sure to contact our team.
