Osteoporosis surgery: Difference between revisions

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__NOTOC__
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{{Osteoporosis}}
{{Osteoporosis}}
{{CMG}}; {{AE}}{{CZ}}, {{RT}}, {{CP}}
{{CMG}}; {{AE}}{{EG}}


==Overview==
==Overview==
[[Surgery]] is not the [[first-line treatment]] option for patients with [[osteoporosis]]. [[Vertebroplasty]], [[kyphoplasty]], lordoplasty, and vesselplasty are procedures that usually reserved for [[patients]] with either [[pathological]] or [[Osteoporosis|osteoporotic]] [[vertebral]] [[fracture]]<nowiki/>s in patients, refractory to [[Medical therapy template|medical therapy]]. [[Surgery]] options for [[osteoporosis]] are very limited. In case of [[hip fracture]] [[open reduction internal fixation]] or in rare cases [[Hip replacement surgery|total hip replacement]] [[surgery]] are the options.
[[Surgery]] is not the [[first-line treatment]] option for patients with osteoporosis. [[Vertebroplasty]], [[kyphoplasty]], lordoplasty, and vesselplasty are the procedures that are usually reserved for [[patients]] with either [[pathological]] or osteoporotic [[vertebral]] [[fracture]]<nowiki/>s and also in patients refractory to [[Medical therapy template|medical therapy]]. [[Surgery]] options for osteoporosis are very limited. In case of [[hip fracture]], [[open reduction internal fixation]] or [[Hip replacement surgery|total hip replacement]] [[surgery]], in rare cases, are the options.


==Surgery==
==Surgery==
[[Surgery]] is not the [[first-line treatment]] option for patients with [[osteoporosis]]. [[Vertebroplasty]], [[kyphoplasty]], lordoplasty, and vesselplasty are procedures that is usually reserved for patients with either [[pathological]] or [[Osteoporosis|osteoporotic]] [[vertebral]] [[fracture]]<nowiki/>s in patients, refractory to [[Medical therapy template|medical therapy]]. [[Surgery]] options for [[osteoporosis]] are very limited. In case of [[hip fracture]] [[open reduction internal fixation]] or in rare cases [[Hip replacement surgery|total hip replacement]] [[surgery]] are the options.  
[[Surgery]] is not the [[first-line treatment]] option for patients with osteoporosis. [[Vertebroplasty]], [[kyphoplasty]], lordoplasty, and vesselplasty are the procedures that are usually reserved for [[patients]] with either [[pathological]] or osteoporotic [[vertebral]] [[fracture]]<nowiki/>s and also in patients refractory to [[Medical therapy template|medical therapy]]. [[Surgery]] options for osteoporosis are very limited. In case of [[hip fracture]], [[open reduction internal fixation]] or [[Hip replacement surgery|total hip replacement]] [[surgery]], in rare cases, are the options.


=== Vertebroplasty ===
{| border="1" cellpadding="2"
The procedure was first performed in 1984 by Galibert and Deramond, French [[neurosurgeons]], in order to treat aggressive [[hemangioma]] in C2 [[vertebra]]. It had very satisfying outcome. The success of this procedure in a favorable way was lead to extend its usage to other destructive [[bone]] [[diseases]], such as [[multiple myeloma]], metastatic [[bone tumors]], and also after a while in 1989, its usage for treatment of [[Osteoporosis|osteoporotic]] [[vertebral fractures]] was proven.<ref name="pmid2757346">{{cite journal |vauthors=Lapras C, Mottolese C, Deruty R, Lapras C, Remond J, Duquesnel J |title=[Percutaneous injection of methyl-metacrylate in osteoporosis and severe vertebral osteolysis (Galibert's technic)] |language=French |journal=Ann Chir |volume=43 |issue=5 |pages=371–6 |year=1989 |pmid=2757346 |doi= |url=}}</ref>
|- style="background:#efefef;" |
! Fracture site
! Surgery method
! Brief description
! Indications
! Contraindications
! Complications
|-
| rowspan="4" |'''Vertebrae'''
| [[Vertebroplasty|'''Vertebroplasty''']]<br>  {{#ev:youtube|L_NpAJND_II}}
|
* [[Minimally invasive surgery]]
* Image-guided by [[fluoroscopy]]
* [[Bone cement]] [[Polymethylmethacrylate|(PMMA)]] injection in [[fractured]] [[vertebra]]
|
* [[Osteoporosis|Osteoporotic]] patients [[refractory]] to medical therapy
* Encountering [[vertebral fracture]]
|
* Asymptomatic [[vertebral fractures]]
* Reasonable response to [[Medical therapy template|medical therapy]]
* Severe [[coagulopathies]]
* Any ongoing local/systemic [[infection]].
|
* [[Cement]] leakage into other spaces (e.g., paraspinal, intradiskal)
* Compression destruction of [[Nerve root|nerve roots]] due to cement leakage
* [[Pulmonary embolism]]
* Cardiac perforation
* Adjacent [[vertebrae fracture]]
|-
| [[Kyphoplasty|'''Kyphoplasty''']]
|
* Adjunctive method for [[vertebroplasty]]
* Initially a [[balloon]] inflated in the [[Vertebral Fractures|fractured vertebra]]  
* Larger amount of [[bone cement]] is applied to meet the original [[vertebral]] height and lesser amount of [[cement]] [[extravasation]]
|
* [[Pain]] control in [[Osteoporosis|osteoporotic]] patients
* [[Vertebral]] [[tumors]] [[refractory]] to [[Medical therapy template|medical therapy]], encountering [[vertebral fracture]]
|
* [[Infection]]
* [[Coagulation disorders]]
* [[Allergy]] to [[bone cement]]
* Anatomical variations
** Posterior [[vertebral]] [[cortical bone]] fusion
** Retroverted fragments
|
* [[Cement]] [[leakage]]
* [[Pulmonary embolism]]  
* Rarely balloon rupture
|-
| '''Lordoplasty'''<br>
|
* Applying 6 [[Cannula|cannulas]] (2 [[pedicles]] each) for any single [[fracture]] site in [[vertebrae]]
* Intact [[cranial]] and [[caudal]] [[vertebrae]] are injected with denser [[cement]]
* Other [[Cannula|cannulas]] (4 [[pedicles]] each) introduced
* [[Kyphosis|Kyphotic]] [[Osteoporosis|osteoporotic]] [[vertebra]] pushed toward the [[lordosis]] with support of [[cranial]] and [[caudal]] [[vertebrae]]
* [[Vertebral]] positions are allied by cross bolt, while 2 [[Cannula|cannulas]] in fracture site deliver the [[PMMA]] cement to the collapsed [[vertebra]]
* When [[cement]] becomes hard, [[Cannula|cannulas]] are replaced from the site
|
* [[Osteoporosis|Osteoporotic]] and [[Vertebral fracture|pathological vertebral fractures]]
|
* [[Infection]]
* [[Coagulation disorders]]
* [[Allergy]] to [[bone cement]]
* [[Anatomical]] variations
** Posterior [[vertebral]] [[cortical bone]] fusion
** Retroverted fragments


In any [[patients]] that are [[refractory]] to long term [[Medical therapy template|medical therapy]] and encountering [[vertebral]] [[compression fracture]], [[vertebroplasty]] would be a good option. [[Vertebroplasty]] is a [[minimally invasive surgery]] that is an image-guided by [[fluoroscopy]] assistance. In this method some [[bone cement]] (mostly [[Polymethylmethacrylate|polymethylmethacrylate (PMMA)]]) is injected in the body of [[vertebra]] that been [[fractured]]. This procedure may lead to improve stability of [[Vertebral Fractures|fractured vertebra]], take it back to the normal shape. [[PMMA]] injection is done under precise [[fluoroscopic]] observation to prevent any leakage of cement into [[spinal canal]]. The most important advantages of the [[vertebroplasty]] procedure are minimal invasion rather than other open [[Surgery|surgical]] methods, and rapid symptomatic relief compare to other [[medical]] treatments.<ref name="pmid28690739">{{cite journal |vauthors=Hemama M, El Fatemi N, Gana R |title=Percutaneous vertebroplasty in Moroccan patients with vertebral compression fractures |journal=Pan Afr Med J |volume=26 |issue= |pages=225 |year=2017 |pmid=28690739 |pmc=5491720 |doi=10.11604/pamj.2017.26.225.9872 |url=}}</ref> 
|
* [[Cement]] leakage (from 6 [[Cannula|cannulas]] in [[vertebrae]])
|-
| '''Vesselplasty'''<br>  {{#ev:youtube|89o6r8bcs0w}}
|
* Pre-injection of some "[[porous]]"  [[polyethylene terephthalate]] in [[vertebral bodies]]
* Prepare some hollow container in place for [[cement]] injection
* [[Cement]] injected in the [[vertebral bodies]]
* The [[vertebrae]] will be more stable and have less height loss during the time
|
* [[Osteoporosis|Osteoporotic]] [[vertebral fracture]]  
* Pathological [[vertebral fracture]] due to soft tumor tissues
|
* [[Infection]]
* [[Coagulation disorders]]
* [[Allergy]] to [[bone cement]]
* Anatomical variations
** Posterior [[vertebral]] [[cortical bone]] fusion
** Retroverted fragments
|
* Any [[allergic reaction]] to [[bone cement]] or other material that used during operation
* [[Pneumothorax]]
* [[Pulmonary embolism]]
* [[Epidural hematoma]]
* Arterial injury
* [[Anterior spinal artery syndrome]]
* Death
|-
| rowspan="2" |'''Hip'''
| [[Open reduction internal fixation|'''Open reduction internal fixation (ORIF)''']]
|
* [[Open surgery]] to set [[Bone fracture|fractured]] [[Bone|bones]] together
* Fixation of screws and/or plates to enable or facilitate [[healing]]
|
* [[Osteoporosis|Osteoporotic]] [[hip fracture]] with segments misalignment
|
* [[Infection]]
* [[Coagulation disorders]]
* Severe [[osteoporosis]]
|
* Nonunion
* Malunion
* [[Fat embolism syndrome|Fat embolism]]
* [[Claudication]]
|-
| [[Hip replacement surgery|'''Total hip replacement''']]
|
* [[Open surgery]] to excise[[Osteoporosis|osteoporotic]] [[hip joint]]
* Replacement of the [[joint]] with [[prosthesis]]
|
* [[Osteoporosis|Osteoporotic]] [[hip joint]]
* [[Avascular necrosis]] (AVN)
* Traumatized and malaligned joint
* Joint stiffness
|
* [[Infection]]
* [[Coagulation disorders]]
* Severe [[osteoporosis]]
|
* [[Joint]] [[instability]]
* Feet length difference
* [[Fat embolism syndrome|Fat embolism]]
* [[Claudication]]
|}


[[Vertebroplasty]] may cause rapid response in patients with [[osteoporosis]]. The patients may experience immediate [[pain]] and discomfort relief, along with gradual correction of [[Kyphosis|stooped spine (kyphosis)]] that is occurred because of [[compression fracture]] in anterior aspect of [[vertebrae]]. The main risk for the procedure is that sometimes the [[cement]] injection may compromise the [[Foramina|foraminal spaces]], leading to [[Radicular pain|radicular pains]].<ref name="pmid27072339">{{cite journal |vauthors=El-Fiki M |title=Vertebroplasty, Kyphoplasty, Lordoplasty, Expandable Devices, and Current Treatment of Painful Osteoporotic Vertebral Fractures |journal=World Neurosurg |volume=91 |issue= |pages=628–32 |year=2016 |pmid=27072339 |doi=10.1016/j.wneu.2016.04.016 |url=}}</ref>
=== Vertebroplasty ===
* The procedure was first performed in 1984 by Galibert and Deramond, French [[neurosurgeons]], in order to treat aggressive [[hemangioma]] in C2 [[vertebra]]. It had a very satisfying outcome. The success of this procedure in a favorable way  led to extend its usage to other destructive [[bone]] [[diseases]], such as [[multiple myeloma]], metastatic [[bone tumors]], and also  [[Osteoporosis|osteoporotic]] [[vertebral fractures]].<ref name="pmid2757346">{{cite journal |vauthors=Lapras C, Mottolese C, Deruty R, Lapras C, Remond J, Duquesnel J |title=[Percutaneous injection of methyl-metacrylate in osteoporosis and severe vertebral osteolysis (Galibert's technic)] |language=French |journal=Ann Chir |volume=43 |issue=5 |pages=371–6 |year=1989 |pmid=2757346 |doi= |url=}}</ref>


The mechanism of lowering [[pain]] in [[Osteoporosis|osteoporotic]] patients following [[vertebroplasty]] is not clear completely. Some of the proposed theories are include correcting micro-[[fractures]], along with [[vascular]], [[chemical]], and also thermal factors. It is assumed that either [[temperature]] properties of injected [[cement]] destroys pain receptors, or compression effect of the [[cement]] crushed the [[Nerve ending|nerve endings]] in situ.<ref name="pmid9536480">{{cite journal |vauthors=Cotten A, Boutry N, Cortet B, Assaker R, Demondion X, Leblond D, Chastanet P, Duquesnoy B, Deramond H |title=Percutaneous vertebroplasty: state of the art |journal=Radiographics |volume=18 |issue=2 |pages=311–20; discussion 320–3 |year=1998 |pmid=9536480 |doi=10.1148/radiographics.18.2.9536480 |url=}}</ref>
* In  [[patients]], who are [[refractory]] to long term [[Medical therapy template|medical therapy]] and  have encountered [[vertebral]] [[compression fracture]], [[vertebroplasty]] would be a good option. [[Vertebroplasty]] is a [[minimally invasive surgery]] that needs an image-guided [[fluoroscopy]] assistance. In this method, some [[bone cement]] (mostly [[Polymethylmethacrylate|polymethylmethacrylate (PMMA)]]) is injected into the body of the [[vertebra]] that has been [[fractured]]. This procedure may lead to improve the stability of [[Vertebral Fractures|fractured vertebra]], take it back to the normal shape. [[PMMA]] injection is done under precise [[fluoroscopic]] observation to prevent any leakage of cement into the [[spinal canal]]. The most important advantages of the [[vertebroplasty]] procedure are minimal invasion rather than other open [[Surgery|surgical]] methods, and rapid symptomatic relief as compared to other [[medical]] treatments.<ref name="pmid28690739">{{cite journal |vauthors=Hemama M, El Fatemi N, Gana R |title=Percutaneous vertebroplasty in Moroccan patients with vertebral compression fractures |journal=Pan Afr Med J |volume=26 |issue= |pages=225 |year=2017 |pmid=28690739 |pmc=5491720 |doi=10.11604/pamj.2017.26.225.9872 |url=}}</ref> 


Whereas, in 2009, Kallmes have found that rapid pain relief and symptomatic cure in [[Osteoporosis|osteoporotic]] patients with [[vertebral]] [[compression fracture]] are not significantly different from [[control group]].<ref name="pmid19657122">{{cite journal |vauthors=Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG |title=A randomized trial of vertebroplasty for osteoporotic spinal fractures |journal=N. Engl. J. Med. |volume=361 |issue=6 |pages=569–79 |year=2009 |pmid=19657122 |pmc=2930487 |doi=10.1056/NEJMoa0900563 |url=}}</ref>
* [[Vertebroplasty]] may cause a rapid response in patients with [[osteoporosis]]. The patients may experience immediate [[pain]] and discomfort relief, along with gradual correction of the [[Kyphosis|stooped spine (kyphosis)]] that occurs because of the [[compression fracture]] in the anterior aspect of [[vertebrae]]. The main risk for the procedure is that sometimes the [[cement]] injection may compromise the [[Foramina|foraminal spaces]], leading to [[Radicular pain|radicular pains]].<ref name="pmid27072339">{{cite journal |vauthors=El-Fiki M |title=Vertebroplasty, Kyphoplasty, Lordoplasty, Expandable Devices, and Current Treatment of Painful Osteoporotic Vertebral Fractures |journal=World Neurosurg |volume=91 |issue= |pages=628–32 |year=2016 |pmid=27072339 |doi=10.1016/j.wneu.2016.04.016 |url=}}</ref>


* The mechanism of lowering [[pain]] in [[Osteoporosis|osteoporotic]] patients following [[vertebroplasty]] is not clear completely. Some of the proposed theories include correcting micro-[[fractures]], along with [[vascular]], [[chemical]], and also thermal factors. It is assumed that either [[temperature]] properties of injected [[cement]] destroy pain receptors, or compression effect of the [[cement]] crushed the [[Nerve ending|nerve endings]] in situ.<ref name="pmid9536480">{{cite journal |vauthors=Cotten A, Boutry N, Cortet B, Assaker R, Demondion X, Leblond D, Chastanet P, Duquesnoy B, Deramond H |title=Percutaneous vertebroplasty: state of the art |journal=Radiographics |volume=18 |issue=2 |pages=311–20; discussion 320–3 |year=1998 |pmid=9536480 |doi=10.1148/radiographics.18.2.9536480 |url=}}</ref> In 2009, Kallmes found that rapid pain relief and symptomatic cure in [[Osteoporosis|osteoporotic]] patients with [[vertebral]] [[compression fracture]] was not significantly different from [[control group]].<ref name="pmid19657122">{{cite journal |vauthors=Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG |title=A randomized trial of vertebroplasty for osteoporotic spinal fractures |journal=N. Engl. J. Med. |volume=361 |issue=6 |pages=569–79 |year=2009 |pmid=19657122 |pmc=2930487 |doi=10.1056/NEJMoa0900563 |url=}}</ref>
==== Indications ====
==== Indications ====
Indications for [[vertebroplasty]] for [[osteoporosis]] include [[Osteoporosis|osteoporotic]] patients [[refractory]] to medical therapy, encountering [[vertebral fracture]].
* Indications for [[vertebroplasty]] for [[osteoporosis]] include [[Osteoporosis|osteoporotic]] patients [[refractory]] to medical therapy and having [[vertebral fracture]].


==== Contraindications ====
==== Contraindications ====
* Absolute [[contraindications]] for [[vertebroplasty]] for [[osteoporosis]] include asymptomatic [[vertebral fractures]] and patients with reasonable response to [[Medical therapy template|medical therapy]], as well as severe [[coagulopathies]] or any ongoing local/systemic [[infection]]. However, any [[allergy]] to the [[cement]] or any other materials that may used during the [[operation]] are included, too.<ref name="pmid215001312">{{cite journal |vauthors=Hargunani R, Le Corroller T, Khashoggi K, Murphy KJ, Munk PL |title=Percutaneous vertebral augmentation: the status of vertebroplasty and current controversies |journal=Semin Musculoskelet Radiol |volume=15 |issue=2 |pages=117–24 |year=2011 |pmid=21500131 |doi=10.1055/s-0031-1275594 |url=}}</ref>
* Absolute [[contraindications]] for [[vertebroplasty]] for [[osteoporosis]] include asymptomatic [[vertebral fractures]] and patients with reasonable response to [[Medical therapy template|medical therapy]], as well as severe [[coagulopathies]] or any ongoing local/systemic [[infection]]. However, any [[allergy]] to the [[cement]] or any other material that may be used during the [[operation]] is included, too.<ref name="pmid215001312">{{cite journal |vauthors=Hargunani R, Le Corroller T, Khashoggi K, Murphy KJ, Munk PL |title=Percutaneous vertebral augmentation: the status of vertebroplasty and current controversies |journal=Semin Musculoskelet Radiol |volume=15 |issue=2 |pages=117–24 |year=2011 |pmid=21500131 |doi=10.1055/s-0031-1275594 |url=}}</ref>
* Relative [[contraindications]] for [[vertebroplasty]] for [[osteoporosis]] include some [[fracture]] or defect in posterior aspect of [[vertebral body]] and also [[tumor]] extension into [[spinal canal]]. In case of [[vertebra]] plana, a complication of [[osteoporosis]] that the height of [[vertebral body]] become to one third of its origin, the [[vertebroplasty]] procedure is characterized as relative [[Contraindication|contraindicated]]; in which high rates of [[complications]] may occurred.<ref name="pmid215001312" />  
* Relative [[contraindications]] for [[vertebroplasty]] for [[osteoporosis]] include the [[fracture]] or defect in the [[posterior]] aspect of the [[vertebral body]], [[tumor]] extension into the [[spinal canal]] and [[vertebra]] plana.<ref name="pmid215001312" />  


==== Complications ====
==== Complications ====
Potential [[complications]] of [[vertebroplasty]] for [[Osteoporosis|osteoporotic]] [[Surgery|surgical treatment]] are include [[cement]] leakage into other spaces (e.g., paraspinal, intradiskal, and etc.), compression destruction of [[Nerve root|nerve roots]] due to cement leakage, [[pulmonary embolism]], cardiac perforation, and adjacent [[vertebrae fracture]].<ref name="pmid21623061">{{cite journal |vauthors=Al-Nakshabandi NA |title=Percutaneous vertebroplasty complications |journal=Ann Saudi Med |volume=31 |issue=3 |pages=294–7 |year=2011 |pmid=21623061 |pmc=3119972 |doi=10.4103/0256-4947.81542 |url=}}</ref>
* Potential [[complications]] of [[vertebroplasty]] for [[Osteoporosis|osteoporotic]] [[Surgery|surgical treatment]] include [[cement]] leakage into other spaces (e.g., paraspinal and intradiskal), compression destruction of [[Nerve root|nerve roots]] due to cement leakage, [[pulmonary embolism]], cardiac perforation, and adjacent [[Vertebral fracture|vertebrae fracture]].<ref name="pmid21623061">{{cite journal |vauthors=Al-Nakshabandi NA |title=Percutaneous vertebroplasty complications |journal=Ann Saudi Med |volume=31 |issue=3 |pages=294–7 |year=2011 |pmid=21623061 |pmc=3119972 |doi=10.4103/0256-4947.81542 |url=}}</ref>


=== Kyphoplasty ===
=== Kyphoplasty ===
If the [[Osteoporosis|osteoporotic]] patients referred within 3 months from [[vertebral fracture]], it would be possible to cure the resulted [[kyphosis]] through [[Kyphoplasty|balloon kyphoplasty]], completely. The procedure is in fact an adjunctive method for [[vertebroplasty]], in which initially a [[balloon]] is used to inflate the [[Vertebral Fractures|fractured vertebra]]; then, larger amount of [[bone cement]] is applied there to meet the original [[vertebral]] height and lesser amount of [[cement]] [[extravasation]]. Generally, [[kyphoplasty]] result in favorable outcomes and [[Osteoporosis|osteoporotic]] patients can go back to normal life.<ref name="pmid24462536">{{cite journal |vauthors=Lee JH, Lee DO, Lee JH, Lee HS |title=Comparison of radiological and clinical results of balloon kyphoplasty according to anterior height loss in the osteoporotic vertebral fracture |journal=Spine J |volume=14 |issue=10 |pages=2281–9 |year=2014 |pmid=24462536 |doi=10.1016/j.spinee.2014.01.028 |url=}}</ref>
* If the [[Osteoporosis|osteoporotic]] patient is referred within 3 months from the [[vertebral fracture]], it would be possible to cure the resulted [[kyphosis]] through [[Kyphoplasty|balloon kyphoplasty]], completely. The procedure is, in fact, an adjunctive method for [[vertebroplasty]], in which initially a [[balloon]] is used to inflate the [[Vertebral Fractures|fractured vertebra]]; then, a larger amount of [[bone cement]] is applied there to meet the original [[vertebral]] height and a lesser amount of [[cement]] [[extravasation]]. Generally, [[kyphoplasty]] results in favorable outcomes and [[Osteoporosis|osteoporotic]] patients can go back to normal life.<ref name="pmid24462536">{{cite journal |vauthors=Lee JH, Lee DO, Lee JH, Lee HS |title=Comparison of radiological and clinical results of balloon kyphoplasty according to anterior height loss in the osteoporotic vertebral fracture |journal=Spine J |volume=14 |issue=10 |pages=2281–9 |year=2014 |pmid=24462536 |doi=10.1016/j.spinee.2014.01.028 |url=}}</ref>


It has found that [[kyphoplasty]] is much more better than [[vertebroplasty]] in final outcome, [[spinal]] height correction, and preventing leakage of [[cement]]. [[Kyphoplasty]] has an obvious priority to [[vertebroplasty]] in middle [[spinal]] height correction and also wedge fractures of [[vertebrae]].<ref name="pmid217059182">{{cite journal |vauthors=Kim KH, Kuh SU, Chin DK, Jin BH, Kim KS, Yoon YS, Cho YE |title=Kyphoplasty versus vertebroplasty: restoration of vertebral body height and correction of kyphotic deformity with special attention to the shape of the fractured vertebrae |journal=J Spinal Disord Tech |volume=25 |issue=6 |pages=338–44 |year=2012 |pmid=21705918 |doi=10.1097/BSD.0b013e318224a6e6 |url=}}</ref>
* It has found that [[kyphoplasty]] is better when comapred to [[vertebroplasty]] in the final outcome, [[spinal]] height correction, and preventing leakage of [[cement]]. [[Kyphoplasty]] has an obvious priority to [[vertebroplasty]] in middle [[spinal]] height correction and also wedge [[fractures]] of [[vertebrae]].<ref name="pmid217059182">{{cite journal |vauthors=Kim KH, Kuh SU, Chin DK, Jin BH, Kim KS, Yoon YS, Cho YE |title=Kyphoplasty versus vertebroplasty: restoration of vertebral body height and correction of kyphotic deformity with special attention to the shape of the fractured vertebrae |journal=J Spinal Disord Tech |volume=25 |issue=6 |pages=338–44 |year=2012 |pmid=21705918 |doi=10.1097/BSD.0b013e318224a6e6 |url=}}</ref>


[[Kyphoplasty]] procedure is always last about 1.5 hours. The patient usually need to be observed only a few hours, but in some cases it may be necessary to hospitalize a whole night to ensure about possible complications.<ref name="pmid23074451">{{cite journal |vauthors= |title=Balloon kyphoplasty: an evidence-based analysis |journal=Ont Health Technol Assess Ser |volume=4 |issue=12 |pages=1–45 |year=2004 |pmid=23074451 |pmc=3387743 |doi= |url=}}</ref>  
* [[Kyphoplasty]] procedure last about 1.5 hours. The patient usually needs to be observed for only a few hours, but in some cases, it may be necessary to hospitalize the patient for a day.<ref name="pmid23074451">{{cite journal |vauthors= |title=Balloon kyphoplasty: an evidence-based analysis |journal=Ont Health Technol Assess Ser |volume=4 |issue=12 |pages=1–45 |year=2004 |pmid=23074451 |pmc=3387743 |doi= |url=}}</ref>


==== Indications ====
==== Indications ====
[[Indications and usage|Indications]] for [[kyphoplasty]] for [[osteoporosis]] include [[pain]] control in [[Osteoporosis|osteoporotic]] patients or [[vertebral]] [[tumors]] [[refractory]] to [[Medical therapy template|medical therapy]], encountering [[vertebral fracture]].<ref name="pmid27072339" />
* [[Indications and usage|Indications]] for [[kyphoplasty]] include:
** [[Pain]]
** [[Vertebral]] [[tumors]] [[refractory]] to [[Medical therapy template|medical therapy]]
** [[Vertebral fracture]].<ref name="pmid27072339" />


==== Contraindications ====
==== Contraindications ====
[[Contraindications]] for [[kyphoplasty]] for [[osteoporosis]] include [[infection]], [[coagulation disorders]], [[allergy]] to [[bone cement]] or any other material that may used during the operation, and also any anatomical variations that would disturb the normal rout of [[surgery]], such as posterior [[vertebral]] [[cortical bone]] fusion and retroverted fragments.<ref name="pmid27072339" />
[[Contraindications]] for [[kyphoplasty]] for [[osteoporosis]] include:
*[[Infection]]  
*[[Coagulation disorders]],  
*[[Allergy]] to [[bone cement]] or any other material that may be used during the operation
*Any anatomical variations that would disturb the normal route of [[surgery]], such as [[posterior]] [[vertebral]] [[cortical bone]] fusion and retroverted fragments.<ref name="pmid27072339" />


==== Complications ====
==== Complications ====
Line 47: Line 184:


=== Lordoplasty ===
=== Lordoplasty ===
The most cost effective procedure to alleviate the [[Compression fracture|compress fractures]] in [[vertebrae]] is lordoplasty. The procedure is commonly done following [[kyphoplasty]], when the balloon become deflated and the [[vertebra]] is ready to inject [[cement]] in. This procedure often used as [[vertebroplasty]] alternative as more cost effective. This procedure, however, may correct the [[Kyphosis|kyphotic]] angle of [[spinal column]] 11 to 13 degrees, leading to significant [[pain]] relief in 90% of patients.<ref name="pmid26895528">{{cite journal |vauthors=Hoppe S, Budmiger M, Bissig P, Aghayev E, Benneker LM |title=Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures |journal=J Neurosurg Spine |volume=24 |issue=6 |pages=922–7 |year=2016 |pmid=26895528 |doi=10.3171/2015.10.SPINE151016 |url=}}</ref> Lordoplasty has a much better 3 months outcome than [[kyphoplasty]], especially in postural and anatomical deviations.<ref name="pmid21165313">{{cite journal |vauthors=Kim SB, Jeon TS, Lee WS, Roh JY, Kim JY, Park WK |title=Comparison of kyphoplasty and lordoplasty in the treatment of osteoporotic vertebral compression fracture |journal=Asian Spine J |volume=4 |issue=2 |pages=102–8 |year=2010 |pmid=21165313 |pmc=2996621 |doi=10.4184/asj.2010.4.2.102 |url=}}</ref>
* The most cost effective procedure to alleviate the [[vertebrae|vertebral]] [[compression fracture]] is lordoplasty.  
* It is commonly done following [[kyphoplasty]], when the balloon is deflated and the [[vertebrae]] is ready to be injected with [[cement]]. It is often used as an alternative to [[vertebroplasty]] as it is more cost effective. This procedure may correct the [[Kyphosis|kyphotic]] angle of the [[spinal column]] by 11 to 13 degrees, leading to significant [[pain]] relief in 90% of patients.<ref name="pmid26895528">{{cite journal |vauthors=Hoppe S, Budmiger M, Bissig P, Aghayev E, Benneker LM |title=Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures |journal=J Neurosurg Spine |volume=24 |issue=6 |pages=922–7 |year=2016 |pmid=26895528 |doi=10.3171/2015.10.SPINE151016 |url=}}</ref> Lordoplasty has a much better 3 months outcome than [[kyphoplasty]], especially in postural and anatomical deviations.<ref name="pmid21165313">{{cite journal |vauthors=Kim SB, Jeon TS, Lee WS, Roh JY, Kim JY, Park WK |title=Comparison of kyphoplasty and lordoplasty in the treatment of osteoporotic vertebral compression fracture |journal=Asian Spine J |volume=4 |issue=2 |pages=102–8 |year=2010 |pmid=21165313 |pmc=2996621 |doi=10.4184/asj.2010.4.2.102 |url=}}</ref>


The procedure consists of applying 6 [[Cannula|cannulas]] , each of them has 2 [[pedicles]], for any single [[fracture]] site in [[vertebrae]]. On the other hand, the intact [[cranial]] and [[caudal]] [[vertebrae]] are injected with denser [[cement]] to be introduced and strengthened with [[Cannula|cannulas]] that have 4 [[pedicles]]. Then, with support of [[cranial]] and [[caudal]] [[vertebrae]], the [[Kyphosis|kyphotic]] [[Osteoporosis|osteoporotic]] [[vertebra]] could be pushed toward the [[lordosis]] and rearranged in normal position. All [[vertebral]] positions are allied by use of a cross bolt, while 2 [[Cannula|cannulas]] in fracture site deliver the [[PMMA]] cement to the collapsed [[vertebra]]; been left to [[cement]] become hard. Finally, [[Cannula|cannulas]] are replaced from the site.<ref name="pmid21629479">{{cite journal| author=Jeon TS, Kim SB, Park WK| title=Lordoplasty: an alternative technique for the treatment of osteoporotic compression fracture. | journal=Clin Orthop Surg | year= 2011 | volume= 3 | issue= 2 | pages= 161-6 | pmid=21629479 | doi=10.4055/cios.2011.3.2.161 | pmc=3095789 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21629479  }}</ref>
* The procedure consists of applying 6 [[Cannula|cannulas]], each of them has 2 [[pedicles]], for any single [[fracture]] site in [[vertebrae]]. On the other hand, the intact [[cranial]] and [[caudal]] [[vertebrae]] are injected with dense [[cement]] and strengthened with [[Cannula|cannulas]] that have 4 [[pedicles]]. Then, with the support of [[cranial]] and [[caudal]] [[vertebrae]], the [[Kyphosis|kyphotic]] [[Osteoporosis|osteoporotic]] [[vertebra]] could be pushed toward the [[lordosis]] and rearranged in a normal position. All [[vertebral]] positions are allied by use of a cross bolt, while 2 [[Cannula|cannulas]] in fracture site deliver the [[Polymethylmethacrylate|polymethylmethacrylate (PMMA)]] [[cement]] to the collapsed [[vertebra]]; been left to [[cement]] become hard. Finally, [[Cannula|cannulas]] are replaced from the site.<ref name="pmid21629479">{{cite journal| author=Jeon TS, Kim SB, Park WK| title=Lordoplasty: an alternative technique for the treatment of osteoporotic compression fracture. | journal=Clin Orthop Surg | year= 2011 | volume= 3 | issue= 2 | pages= 161-6 | pmid=21629479 | doi=10.4055/cios.2011.3.2.161 | pmc=3095789 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21629479  }}</ref>


==== Indications ====
==== Indications ====
Indications for lordoplasty for [[osteoporosis]] include [[Osteoporosis|osteoporotic]] and [[Vertebral fracture|pathological vertebral fractures]].
Indications for lordoplasty for [[osteoporosis]] include
* [[Osteoporosis|Osteoporotic fractures]]  
* [[Vertebral fracture|Pathological vertebral fractures]].


==== Contraindications ====
==== Contraindications ====
[[Contraindications]] for [[surgery]] for [[osteoporosis]] include [[infection]], [[coagulation disorders]], [[allergy]] to [[bone cement]] or any other material that may used during the operation, and also any anatomical variations that would disturb the normal rout of [[surgery]], such as posterior [[vertebral]] [[cortical bone]] fusion and retroverted fragments.<ref name="pmid27072339" />
[[Contraindications]] for [[surgery]] for [[osteoporosis]] include:
* [[Infection]]
* [[Coagulation disorders]]  
* [[Allergy]] to [[bone cement]] or any other material used during the operation
* Any anatomical variations that would disturb the normal route of [[surgery]], such as [[posterior]] [[vertebral]] [[cortical bone]] fusion and retroverted fragments.<ref name="pmid27072339" />


==== Complications ====
==== Complications ====
Regarding that 6 [[Cannula|cannulas]] are introduced in [[vertebrae]], the most important complication of lordoplasty may be [[cement]] leakage. The cement high [[viscosity]] and wide [[Cannula|cannulas]] used to inject the [[cement]] are the solutions for the problems.
*[[Cement]] leakage as 6 [[Cannula|cannulas]] are introduced in [[vertebrae]]. High [[viscosity]] [[cement]] and wide [[Cannula|cannulas]] may be used to inject the [[cement]] to prevent the [[cement]] leakage.


=== Vesselplasty ===
=== Vesselplasty ===
This procedure is based on pre-injection of some "[[porous]]" material, [[polyethylene terephthalate]], in the site of [[Osteoporosis|osteoporotic]] [[vertebral fracture]]. The main purpose is to prepare some hollow container in place that the [[cement]] is about to injected in; therefore, the [[cement]] goes through the [[vertebral bodies]] much deeper and leak back from there so much lesser than [[kyphoplasty]] or lordoplasty. The concluded [[vertebrae]] will be more stable and have less height loss during the time.<ref name="pmid19542417">{{cite journal| author=Flors L, Lonjedo E, Leiva-Salinas C, Martí-Bonmatí L, Martínez-Rodrigo JJ, López-Pérez E et al.| title=Vesselplasty: a new technical approach to treat symptomatic vertebral compression fractures. | journal=AJR Am J Roentgenol | year= 2009 | volume= 193 | issue= 1 | pages= 218-26 | pmid=19542417 | doi=10.2214/AJR.08.1503 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19542417  }}</ref>
[[image: Vessel-X whole.jpg|400px|right|thumb| The instrument used in vesselplasty - By Aspine, Via: Wikimedia.org<ref>Own work, CC BY-SA 3.0, <https://commons.wikimedia.org/w/index.php?curid=7614604></ref>]]
* This procedure is based on pre-injection of a "[[porous]]" material, [[polyethylene terephthalate]], at the site of [[Osteoporosis|osteoporotic]] [[vertebral fracture]]. The main purpose is to prepare a hollow container in a place where the [[cement]] is about to be injected; therefore, the [[cement]] goes through the [[vertebral bodies]] much deeper and has lesser chances of leakage than [[kyphoplasty]] or lordoplasty. The operated [[vertebrae]] will be more stable and have lesser height loss during the time.<ref name="pmid19542417">{{cite journal| author=Flors L, Lonjedo E, Leiva-Salinas C, Martí-Bonmatí L, Martínez-Rodrigo JJ, López-Pérez E et al.| title=Vesselplasty: a new technical approach to treat symptomatic vertebral compression fractures. | journal=AJR Am J Roentgenol | year= 2009 | volume= 193 | issue= 1 | pages= 218-26 | pmid=19542417 | doi=10.2214/AJR.08.1503 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19542417  }}</ref>


Mainly, [[kyphoplasty]] procedure is to inject the [[cement]] materials in [[Vertebral Fractures|fractured vertebrae]] in place of removed deflated balloon, that is the main fact of correction in [[vertebral]] [[Osteoporosis|osteoporotic]] [[fractures]]. Whereas, in some cases the main tissue in place is not as hard as main [[vertebral]] [[bone]] tissue and may collapsed after removing or deflating the balloon, such as soft [[tumor]] tissue that has led to pathological [[fracture]], indeed. The best way to solve this problem is a modified [[kyphoplasty]], also named vesselplasty, used to treat [[Osteoporosis|osteoporotic]] [[fractures]]. The non-stretchable balloon that is used in vesselplasty to inject the [[cement]] through, prevent the re-collapse of soft tissue around the [[fracture]].<ref name="pmid23471680">{{cite journal |vauthors=Klingler JH, Sircar R, Deininger MH, Scheiwe C, Kogias E, Hubbe U |title=Vesselplasty: a new minimally invasive approach to treat pathological vertebral fractures in selected tumor patients - preliminary results |journal=Rofo |volume=185 |issue=4 |pages=340–50 |year=2013 |pmid=23471680 |doi=10.1055/s-0032-1330443 |url=}}</ref>
* Vesselplasty is also known as modified [[kyphoplasty]] as it uses a non-stretchable balloon  to inject the [[cement]] material into the fractured [[Vertebrae|vertebra]]. It not only prevents the [[cement]] leakage but also the re-collapse of soft tissue around the [[fracture]].<ref name="pmid23471680">{{cite journal |vauthors=Klingler JH, Sircar R, Deininger MH, Scheiwe C, Kogias E, Hubbe U |title=Vesselplasty: a new minimally invasive approach to treat pathological vertebral fractures in selected tumor patients - preliminary results |journal=Rofo |volume=185 |issue=4 |pages=340–50 |year=2013 |pmid=23471680 |doi=10.1055/s-0032-1330443 |url=}}</ref>


Vesselplasty, like [[kyphoplasty]], has safer [[cement]] delivery to the [[Fractures|fractured]] [[bone]] and also less [[cement]] leakage, postoperatively.<ref name="pmid19740423">{{cite journal |vauthors=Bouza C, López-Cuadrado T, Cediel P, Saz-Parkinson Z, Amate JM |title=Balloon kyphoplasty in malignant spinal fractures: a systematic review and meta-analysis |journal=BMC Palliat Care |volume=8 |issue= |pages=12 |year=2009 |pmid=19740423 |pmc=2746801 |doi=10.1186/1472-684X-8-12 |url=}}</ref>
* Vesselplasty, like [[kyphoplasty]], has safe [[cement]] delivery to the [[Fractures|fractured]] [[bone]] and also less [[cement]] leakage, postoperatively.<ref name="pmid19740423">{{cite journal |vauthors=Bouza C, López-Cuadrado T, Cediel P, Saz-Parkinson Z, Amate JM |title=Balloon kyphoplasty in malignant spinal fractures: a systematic review and meta-analysis |journal=BMC Palliat Care |volume=8 |issue= |pages=12 |year=2009 |pmid=19740423 |pmc=2746801 |doi=10.1186/1472-684X-8-12 |url=}}</ref>


==== Indications ====
==== Indications ====
Indications for vesselplasty for [[osteoporosis]] include patients with [[Osteoporosis|osteoporotic]] [[vertebral fracture]] and also pathological [[vertebral fracture]] due to soft tumor tissues.
Indications for vesselplasty for [[osteoporosis]] include:
*[[Osteoporosis|Osteoporotic]] [[vertebral fracture]]  
*Pathological [[vertebral fracture]] due to soft tumor tissues.


==== Contraindications ====
==== Contraindications ====
[[Contraindications]] for [[surgery]] for [[osteoporosis]] include [[infection]], [[coagulation disorders]], [[allergy]] to [[bone cement]] or any other material that may used during the operation, and also any anatomical variations that would disturb the normal rout of [[surgery]], such as posterior [[vertebral]] [[cortical bone]] fusion and retroverted fragments.<ref name="pmid27072339" />
[[Contraindications]] include:
*[[Infection]]
*[[Coagulation disorders]]
*[[Allergy]] to [[bone cement]] or any other material used during the operation
*[[Anatomical]] variations that would disturb the normal route of [[surgery]], such as [[posterior]] [[vertebral]] [[cortical bone]] fusion and retroverted fragments.<ref name="pmid27072339" />


==== Complications ====
==== Complications ====
The [[complications]] of vesselplasty procedure include any [[allergic reaction]] to [[bone cement]] or other material that used during operation, [[pneumothorax]], [[pulmonary embolism]], [[epidural hematoma]], arterial injury, [[anterior spinal artery syndrome]], and death.<ref name="pmid23471680" />
The [[complications]] of vesselplasty include:
* [[Allergic reaction]] to [[bone cement]] or other material used during the operation,
* [[Pneumothorax]],
* [[Pulmonary embolism]],
* [[Epidural hematoma]],  
* Arterial injury such as [[anterior spinal artery syndrome]].<ref name="pmid23471680" />


=== Hip fracture surgery ===
=== Hip fracture surgery ===
[[Hip fractures]] are treated by [[open reduction internal fixation]] (ORIF).
* [[Hip fractures]] may be treated by [[Open reduction internal fixation|open reduction internal fixation (ORIF)]].
 
* Some patients with a [[hip fracture]] who are at high risk for another [[fracture]] may benefit from a total [[hip replacement surgery]].
Some patients with a [[hip fracture]] who are at high risk for another [[fracture]], may benefit from a total hip replacement surgery.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WS}}
{{WH}}


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[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Radiology]]
[[Category:Up-To-Date]]
[[Category:Orthopedics]]
[[Category:Surgery]]
[[Category:Primary care]]

Latest revision as of 23:29, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Surgery is not the first-line treatment option for patients with osteoporosis. Vertebroplasty, kyphoplasty, lordoplasty, and vesselplasty are the procedures that are usually reserved for patients with either pathological or osteoporotic vertebral fractures and also in patients refractory to medical therapy. Surgery options for osteoporosis are very limited. In case of hip fracture, open reduction internal fixation or total hip replacement surgery, in rare cases, are the options.

Surgery

Surgery is not the first-line treatment option for patients with osteoporosis. Vertebroplasty, kyphoplasty, lordoplasty, and vesselplasty are the procedures that are usually reserved for patients with either pathological or osteoporotic vertebral fractures and also in patients refractory to medical therapy. Surgery options for osteoporosis are very limited. In case of hip fracture, open reduction internal fixation or total hip replacement surgery, in rare cases, are the options.

Fracture site Surgery method Brief description Indications Contraindications Complications
Vertebrae Vertebroplasty
{{#ev:youtube|L_NpAJND_II}}
Kyphoplasty
Lordoplasty
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Hip Open reduction internal fixation (ORIF)
Total hip replacement

Vertebroplasty

Indications

Contraindications

Complications

Kyphoplasty

  • Kyphoplasty procedure last about 1.5 hours. The patient usually needs to be observed for only a few hours, but in some cases, it may be necessary to hospitalize the patient for a day.[10]

Indications

Contraindications

Contraindications for kyphoplasty for osteoporosis include:

Complications

The main complication is cement leakage following the procedure. Other possible complications include pulmonary embolism and rarely balloon rupture.[11]

Lordoplasty

  • The most cost effective procedure to alleviate the vertebral compression fracture is lordoplasty.
  • It is commonly done following kyphoplasty, when the balloon is deflated and the vertebrae is ready to be injected with cement. It is often used as an alternative to vertebroplasty as it is more cost effective. This procedure may correct the kyphotic angle of the spinal column by 11 to 13 degrees, leading to significant pain relief in 90% of patients.[12] Lordoplasty has a much better 3 months outcome than kyphoplasty, especially in postural and anatomical deviations.[13]

Indications

Indications for lordoplasty for osteoporosis include

Contraindications

Contraindications for surgery for osteoporosis include:

Complications

Vesselplasty

The instrument used in vesselplasty - By Aspine, Via: Wikimedia.org[15]
  • Vesselplasty is also known as modified kyphoplasty as it uses a non-stretchable balloon to inject the cement material into the fractured vertebra. It not only prevents the cement leakage but also the re-collapse of soft tissue around the fracture.[17]

Indications

Indications for vesselplasty for osteoporosis include:

Contraindications

Contraindications include:

Complications

The complications of vesselplasty include:

Hip fracture surgery

References

  1. ↑ Lapras C, Mottolese C, Deruty R, Lapras C, Remond J, Duquesnel J (1989). "[Percutaneous injection of methyl-metacrylate in osteoporosis and severe vertebral osteolysis (Galibert's technic)]". Ann Chir (in French). 43 (5): 371–6. PMID 2757346.
  2. ↑ Hemama M, El Fatemi N, Gana R (2017). "Percutaneous vertebroplasty in Moroccan patients with vertebral compression fractures". Pan Afr Med J. 26: 225. doi:10.11604/pamj.2017.26.225.9872. PMC 5491720. PMID 28690739.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 El-Fiki M (2016). "Vertebroplasty, Kyphoplasty, Lordoplasty, Expandable Devices, and Current Treatment of Painful Osteoporotic Vertebral Fractures". World Neurosurg. 91: 628–32. doi:10.1016/j.wneu.2016.04.016. PMID 27072339.
  4. ↑ Cotten A, Boutry N, Cortet B, Assaker R, Demondion X, Leblond D, Chastanet P, Duquesnoy B, Deramond H (1998). "Percutaneous vertebroplasty: state of the art". Radiographics. 18 (2): 311–20, discussion 320–3. doi:10.1148/radiographics.18.2.9536480. PMID 9536480.
  5. ↑ Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009). "A randomized trial of vertebroplasty for osteoporotic spinal fractures". N. Engl. J. Med. 361 (6): 569–79. doi:10.1056/NEJMoa0900563. PMC 2930487. PMID 19657122.
  6. ↑ 6.0 6.1 Hargunani R, Le Corroller T, Khashoggi K, Murphy KJ, Munk PL (2011). "Percutaneous vertebral augmentation: the status of vertebroplasty and current controversies". Semin Musculoskelet Radiol. 15 (2): 117–24. doi:10.1055/s-0031-1275594. PMID 21500131.
  7. ↑ Al-Nakshabandi NA (2011). "Percutaneous vertebroplasty complications". Ann Saudi Med. 31 (3): 294–7. doi:10.4103/0256-4947.81542. PMC 3119972. PMID 21623061.
  8. ↑ Lee JH, Lee DO, Lee JH, Lee HS (2014). "Comparison of radiological and clinical results of balloon kyphoplasty according to anterior height loss in the osteoporotic vertebral fracture". Spine J. 14 (10): 2281–9. doi:10.1016/j.spinee.2014.01.028. PMID 24462536.
  9. ↑ Kim KH, Kuh SU, Chin DK, Jin BH, Kim KS, Yoon YS, Cho YE (2012). "Kyphoplasty versus vertebroplasty: restoration of vertebral body height and correction of kyphotic deformity with special attention to the shape of the fractured vertebrae". J Spinal Disord Tech. 25 (6): 338–44. doi:10.1097/BSD.0b013e318224a6e6. PMID 21705918.
  10. ↑ "Balloon kyphoplasty: an evidence-based analysis". Ont Health Technol Assess Ser. 4 (12): 1–45. 2004. PMC 3387743. PMID 23074451.
  11. ↑ Ledlie JT, Renfro M (2003). "Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels". J. Neurosurg. 98 (1 Suppl): 36–42. PMID 12546386.
  12. ↑ Hoppe S, Budmiger M, Bissig P, Aghayev E, Benneker LM (2016). "Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures". J Neurosurg Spine. 24 (6): 922–7. doi:10.3171/2015.10.SPINE151016. PMID 26895528.
  13. ↑ Kim SB, Jeon TS, Lee WS, Roh JY, Kim JY, Park WK (2010). "Comparison of kyphoplasty and lordoplasty in the treatment of osteoporotic vertebral compression fracture". Asian Spine J. 4 (2): 102–8. doi:10.4184/asj.2010.4.2.102. PMC 2996621. PMID 21165313.
  14. ↑ Jeon TS, Kim SB, Park WK (2011). "Lordoplasty: an alternative technique for the treatment of osteoporotic compression fracture". Clin Orthop Surg. 3 (2): 161–6. doi:10.4055/cios.2011.3.2.161. PMC 3095789. PMID 21629479.
  15. ↑ Own work, CC BY-SA 3.0, <https://commons.wikimedia.org/w/index.php?curid=7614604>
  16. ↑ Flors L, Lonjedo E, Leiva-Salinas C, Martí-Bonmatí L, Martínez-Rodrigo JJ, López-Pérez E; et al. (2009). "Vesselplasty: a new technical approach to treat symptomatic vertebral compression fractures". AJR Am J Roentgenol. 193 (1): 218–26. doi:10.2214/AJR.08.1503. PMID 19542417.
  17. ↑ 17.0 17.1 Klingler JH, Sircar R, Deininger MH, Scheiwe C, Kogias E, Hubbe U (2013). "Vesselplasty: a new minimally invasive approach to treat pathological vertebral fractures in selected tumor patients - preliminary results". Rofo. 185 (4): 340–50. doi:10.1055/s-0032-1330443. PMID 23471680.
  18. ↑ Bouza C, López-Cuadrado T, Cediel P, Saz-Parkinson Z, Amate JM (2009). "Balloon kyphoplasty in malignant spinal fractures: a systematic review and meta-analysis". BMC Palliat Care. 8: 12. doi:10.1186/1472-684X-8-12. PMC 2746801. PMID 19740423.

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