Vertebroplasty and kyphoplasty in osteoporotic vertebral fractures

Osteoporotic vertebral fractures are a cause of incapacitating pain. Multiple vertebral osteoporotic fractures induce vertebral kyphosis and functional disability. Vertebroplasty and kyphoplasty are two percutaneous procedures proposed in painful vertebral osteoporotic fractures. They consist in percutaneous injection of methylmetacrylate into the fractured vertebral body. In addition, kyphoplasty starts with an attempt of reexpansion of the vertebral body using expanding balloons. Two 2009 randomized double-blind trials found no difference in pain decrease following either vertebroplasty or a sham intervention. However, more recent randomized trials concluded to the superiority of vertebroplasty on either conservative management or a sham intervention. According to international guidelines, vertebroplasty and kyphoplasty should be indicated only after conservative treatment failure. However, further studies are needed to investigate if performing these procedures earlier can prevent further height loss of the fractured vertebra and increase in vertebral kyphotic angle. Recent studies have shown that advantages of balloon kyphoplasty over vertebroplasty are not sufficient to justify a higher cost and a longer procedure.