Osteoporotic vertebral compression fractures OVCFs have gradually evolved into a serious health care problem globally. In order to reduce the morbidity of OVCF patients and improve their life quality, two minimally invasive surgery procedures, vertebroplasty VP and balloon kyphoplasty BKP , have been developed.
Percutaneous vertebroplasty and kyphoplasty: current status, new developments and old controversies
Both VP and BKP require the injection of bone cement into the vertebrae of patients to stabilize fractured vertebra. As such, bone cement as the filling material plays an essential role in the effectiveness of these treatments. In this review article, we summarize the bone cements that are currently available in the market and those still under development. Two major categories of bone cements, nondegradable acrylic bone cements ABCs and degradable calcium phosphate cements CPCs , are introduced in detail.
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Some vertebroplasty practitioners and some health care professional organizations continue to advocate for the procedure. Vertebral body stenting , also known by the brand Kiva, is a similar procedure which also has poor evidence to support its use. Some of the associated risks are from the leak of acrylic cement to outside of the vertebral body. Although severe complications are extremely rare, infection, bleeding, numbness, tingling, headache, and paralysis may ensue because of misplacement of the needle or cement. This particular risk is decreased by the use of X-ray or other radiological imaging to ensure proper placement of the cement.
The risk of new fractures following these procedures does not appear to be changed; however, evidence is limited,  and an increase risk as of is not ruled out. Vertebroplasty is typically performed by a spine surgeon or interventional radiologist. It is a minimally invasive procedure and patients usually go home the same or next day as the procedure. Patients are given local anesthesia and light sedation for the procedure, though it can be performed using only local anesthetic for patients with medical problems who cannot tolerate sedatives well.
During the procedure, bone cement is injected with a biopsy needle into the collapsed or fractured vertebra. The needle is placed with fluoroscopic x-ray guidance. The cement most commonly PMMA , although more modern cements are used as well quickly hardens and forms a support structure within the vertebra that provide stabilization and strength.
The needle makes a small puncture in the patient's skin that is easily covered with a small bandage after the procedure. Kyphoplasty is a variation of a vertebroplasty which attempts to restore the height and angle of kyphosis of a fractured vertebra of certain types , followed by its stabilization using injected bone cement. The procedure typically includes the use of a small balloon that is inflated in the vertebral body to create a void within the cancellous bone prior to cement delivery.
Once the void is created, the procedure continues in a similar manner as a vertebroplasty, but the bone cement is typically delivered directly into the newly created void.
In a review Medicare contractor NAS determined that there is no difference between vertebroplasty and kyphoplasty, stating, "No clear evidence demonstrates that one procedure is different from another in terms of short- or long-term efficacy, complications, mortality or any other parameter useful for differentiating coverage.
In the United States in approximately 25, vertebroplasty procedures were paid for by medicare. Vertebroplasty had been performed as an open procedure for many decades to secure pedicle screws and fill tumorous voids. However, the results were not always worth the risk involved with an open procedure , which was the reason for the development of percutaneous vertebroplasty. The first percutaneous vertebroplasty was performed in at the University Hospital of Amiens, France to fill a vertebral void left after the removal of a benign spinal tumor.
Percutaneous Vertebral Augmentation
A report of this and 6 other patients was published in and it was introduced in the United States in the early s. Initially, the treatment was used primarily for tumors in Europe and vertebral compression fractures in the United States, although the distinction has largely gone away since then. There were no significant differences in adjusted costs in the first 9 months postsurgery, but kyphoplasty patients were associated with significantly lower adjusted treatment costs by 6.
In response to the NEJM articles and a medical record review showing misuse of vertebroplasty and kyphoplasty, US Medicare contractor Noridian Administrative Services NAS conducted a literature review and formed a policy regarding reimbursement of the procedures. NAS states that in order to be reimbursable, a procedure must meet certain criteria, including, 1 a detailed and extensively documented medical record showing pain caused by a fracture, 2 radiographic confirmation of a fracture, 3 that other treatment plans were attempted for a reasonable amount of time, 4 that the procedure is not performed in the emergency department, and 5 that at least 1 year of follow-up is planned for, among others.
The policy, as referenced, applies only to the region covered by Noridian and not all of Medicare's coverage area. It became effective on 20 June From Wikipedia, the free encyclopedia. A type of spinal procedure. The Cochrane Database of Systematic Reviews. Journal of Bone and Mineral Research.
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