E2301. Cementing the Fracture: Comparing Approaches to Percutaneous Vertebral Augmentation
  1. Christian Law; EVMS Radiology Residency
  2. Daniel O'Neal; University of Pittsburgh Medical Center
  3. Robert Andrews; EVMS Radiology Residency
  4. Christopher Dobzyniak; EVMS Radiology Residency
Vertebral compression fractures (VCFs) are the most common form of osteoporotic fracture, and usually occur from low-trauma events such as falling from a standing height. These fractures may result in significant back pain, limited physical function, and can lead to loss of independence, depression, and chronic pain. VCFs are also associated with height loss, neurological impairment, and increased risk of subsequent fracture. Using interventional radiology techniques, compression fractures can be treated through the injection of bone cement, often under fluoroscopy, into a fractured vertebra percutaneously. The primary goal of this procedure is the improvement of acute pain and patient function, while also being effective in the prevention of further collapse and the preservation of posture. There are two methods of percutaneous vertebral augmentation procedures, vertebroplasty and kyphoplasty. Kyphoplasty differs in that there is an inflatable balloon inserted into the fracture of the vertebral body, creating a low-pressure space for the injection of bone cement. While these procedures are very similar, their efficacy, risk profile, and additional benefits such as patient height restoration are unique. The purpose of this educational exhibit is to familiarize current and future radiologists with these procedures, compare the different surgical approaches, and to discuss their potential outcomes and complications.

Educational Goals / Teaching Points
Educational goals to recognize vertebral compression fractures that would benefit from percutaneous vertebral augmentation on imaging, to review necessary tools and commonly used materials in the procedure, and to give an overview of the steps involved. We will also provide a comparison between different surgical approaches, such as vertebroplasty versus kyphoplasty, unipedicular versus bipedicular, and trans- versus parapedicular. Lastly, we will analyze the efficacy in pain reduction and patient function across the different approaches, as well as review the rates of potential adverse complications of these procedures.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Key pathophysiological issues are morbidity associated with fractures and diseases that may increase risk of fracture. Key imaging findings include examples of proper needle placement, optimal views utilized during procedure, expected intra/post-operative appearance, and complications such as cement leak.

Percutaneous vertebral augmentation is an effective and safe method for treating vertebral compression fractures resulting from osteoporosis. This procedure can avoid potentially severe complications related to back pain and prolonged bed rest, through the immediate pain relief and early mobilization that it allows. There are several different approaches to the procedure, and the choice is largely dependent on patient anatomy, severity of compression fracture, and the surgeon’s preference. Although percutaneous vertebral augmentation is a relatively accessible procedure for an experienced interventionalist, it does have complications, primarily associated with cement extravasation and new adjacent fractures.