Compare and contrast the minimally invasive methods of vertebral augmentation vertebroplasty and kyphoplasty

Vertebroplasty and kyphoplasty are methods of stabilizing fractured vertebral bodies. Both techniques utilize a percutaneous approach to the vertebral body. A cannulated needle is inserted into the body, under fluoroscopy, through one or both pedicles.

• Vertebroplasty is performed by injecting liquid PMMA into the body. The cement fills the voids within the osseous trabeculae to stabilize the fractured vertebra. This is typically less viscous cement than is used in kyphoplasty, which theoretically is more likely to fill the trabecular bone but also more likely to leak out of the vertebral body. Fracture reduction occurs due to dynamic mobility at the fracture site and from patient positioning on the fluoroscopy table

• In kyphoplasty, a balloon is introduced into the body through the working cannula. The balloon is then inflated to create a cavity. Higher viscosity cement than is used in vertebroplasty is then placed into the void created by the balloon tamp and is less likely to leak from the vertebra. The balloon also theoretically aids in reducing the fracture by distracting the vertebral endplates relative to one another (Fig. 66-4)

Figure 66-4. Balloon kyphoplasty, T12 vertebra. A, A 3-mm drill is directed through the anterior extent of the vertebral body after initial placement of 11-gauge needles and subsequent placement of a working cannula. B, Insertion of the inflatable balloon tamp before inflation. C, Inflation of the inflatable balloon tamp filled with sterile saline and radiocontrast dye, anteroposterior view. D, Deposition of bone cement following cavity creation and vertebral height restoration. (From Haaga J, Dogra V, Forsting M, et al. CT and MRI of the Whole Body. 5th ed. Philadelphia: Mosby; 2008.)

Figure 66-4. Balloon kyphoplasty, T12 vertebra. A, A 3-mm drill is directed through the anterior extent of the vertebral body after initial placement of 11-gauge needles and subsequent placement of a working cannula. B, Insertion of the inflatable balloon tamp before inflation. C, Inflation of the inflatable balloon tamp filled with sterile saline and radiocontrast dye, anteroposterior view. D, Deposition of bone cement following cavity creation and vertebral height restoration. (From Haaga J, Dogra V, Forsting M, et al. CT and MRI of the Whole Body. 5th ed. Philadelphia: Mosby; 2008.)

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