Alternatives to Balloon Kyphoplasty for Surgical Treatment of Vertebral Compression Fractures: A State-of-the-Art Review

Abstract

Background: For patients in whom the pain due to osteoporosis-induced vertebral compression fracture(s) is severe, persistent, and refractory to a conservative treatment (such as, analgesics, back bracing, or physical therapy), it is common to resort to surgical intervention, in the form of a vertebral augmentation method, most commonly, balloon kyphoplasty (BKP). Although there are some reports of the efficacy of this procedure (for example, provision of pain relief), there is lack of consensus on this matter as well as recognition of various shortcomings of BKP. Four principal shortcomings are damage to the trabecular bone when the bone tamp is inflated, loss of the restored height in the period between deflation of the bone tamp and injection of the cement dough, extravasation of the cement dough, and fracture of adjacent vertebral body/bodies. Purpose: Presentation of a critical review of clinical performance of alternative surgical methods to BKP that are aimed at addressing the aforementioned and other shortcomings of BKP. Design and Methods: A literature search for articles on BKP and alternative surgical methods was conducted using relevant keywords and public databases, such as PubMed, MEDLINE, and Google Scholar. Results: These comprised succinct descriptions of salient features of various alternative surgical methods, such as radiofrequency kyphoplasty, vertebral body stenting, and lordoplasty; a critical examination of the results of clinical studies involving these methods (in particular, vis a vis BKP); and presentations of suggestions for future study. Conclusion: Various deficiencies of the clinical literature mean that definitive statements cannot be made on each of the alternative surgical methods discussed as a viable alternative to BKP.