Vertebroplasty and kyphoplasty, treatment of vertebral fractures

Concept

Vertebroplasty and kyphoplasty are the treatment of choice in those patients who have suffered vertebral fractures with wedging or crushing of one or more vertebrae. These treatments consist of filling the affected vertebra with cement (Vertebroplasty), or trying to restore the vertebral height with inflatable balloons (Kyphoplasty).

Vertebral fractures are usually caused by trauma in patients with a predisposing factor such as osteoporosis. The lower bone mass of the vertebral bodies reduces their consistency, and sometimes a small trauma can cause the fracture.

Other predisposing factors are smoking, alcohol, corticosteroid treatment, physical inactivity and the postmenopausal period.

The most frequent area in which fractures occur is the thoracolumbar region of the spine.

It is very important to detect and treat this type of fractures early, in order to carry out a minimally invasive treatment.

After 3-6 months, it is possible that the fracture has consolidated and the patient continues to report intense pain. In these cases the kyphoplasty has no effectiveness and we must indicate a treatment by arthrodesis (fixation of the vertebrae).

Vértreba fracturada - vertebroplastia y cifoplastia

Fig.1: Resonance y TC column: Fracture L1

Vértebra fracturada - tratamiento vertebroplastia y cifoplastia Neurovist

 

Symptomatology

The main symptomatology is acute PAIN, it is often referred to as a «clicking» sensation with the trauma. This pain is very disabling and with little response to conventional analgesia.

In the imaging tests you can see how the affected vertebra suffers a crush or wedging, which can affect the posterior wall of the vertebra. Its bulging into the spinal canal can compromise the spinal cord and nerves.

In general, this type of fracture does not produce neurological symptoms, but if the spinal canal is severely affected, it may require emergency decompression treatment.

Treatment: vertebroplasty and kyphoplasty

The minimally invasive treatment of choice is vertebroplasty and kyphoplasty depending on the case. Through this procedure, synthetic cement is injected percutaneously (through the skin) to restore the affected vertebra. They last approximately one hour.

Through cannulas guided by RX (which are introduced into the vertebra through the pedicles), we introduce two balloons that are inflated with a controlled pressure. Subsequently the defect created with the acrylic cement is filled. Once the cement has set, the intervention is over.

These procedures are generally well tolerated, being hospital discharge at 24 hours.

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Dr. Javier Sendra

El Dr. Javier Sendra Tello es especialista en Neurocirugía y Otorrinolaringología por el Hospital Universitario Ramón y Cajal de Madrid. Desde 2012 es coordinador de la Unidad de Neurocirugía Neurovist, unidad de referencia neuroquirúrgica en medicina privada de Alicante. Dr. Javier Sendra Tello is a specialist in Neurosurgery and Otorhinolaryngology at the Ramón y Cajal University Hospital in Madrid. Since 2012 he is coordinator of the Neurovist Neurosurgery Unit, a neurosurgical reference unit in private medicine in Alicante.

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