Radiofrequency kyphoplasty for the treatment of osteoporotic vertebral fractures: A review of the literature

Abstract

Osteoporotic vertebral fractures are a leading cause of disability among the elderly population. Their incidence in Europe has been estimated to be approximately 500.000 fractures per year rendering treatment options of particular importance. While conservative management remains the mainstay of treatment, minimally invasive techniques such as kyphoplasty (KF) and vertebroplasty (VP) offer valuable alternatives, especially in cases of lasting pain. Both of them have well established clinical outcomes in terms of pain relief and functionality improvement. However, concerns regarding the destruction of bone microarchitecture and cement extravasation has led to the introduction of Radiofrequency kyphoplasty, as an alternative. It is a relatively new technique, called also radiofrequencytargeted vertebral augmentation (RF-TVA), which appears to provide comparable outcomes, while it reduces potential adverse effects. It was approved in 2007 in the USA and in 2009 in Germany for the treatment of painful vertebral fractures. RF kyphoplasty is primarily indicated for osteoporotic compression fractures, while it can be reserved in cases of an underlying bone pathology, such as multiple myeloma. Through a unipedicular approach, a navigational osteotome is used to create specific paths inside the cancellous bone preserving to a great extent the microarchitecture of the trabeculae. RF are used to warm the cement and transform it into an ultra-high viscosity mass, thus reducing evidently the risk of cement leakage. This article aims to provide a short review of all available published data evaluating the effectiveness and the benefits of this technique.