Vertebroplasty and kyphoplasty: Techniques, complications, and troubleshooting

Vertebral fractures are very common. The estimated annual incidence is 1.4 million cases worldwide—the most frequent underlying cause being osteoporosis. The first-line treatment for symptomatic Vertebral fractures is generally conservative and is based on analgesics, rest, orthesis, and rehabilitation. However, up to one-third of all patients fail to respond to such treatment and require surgery. In the last 20 years, 2 safe and effective minimally invasive procedures have been developed as an alternative to conservative management and open surgery: vertebroplasty and kyphoplasty. The complications of both these techniques, although infrequent, are not negligible and include infection, bleeding, worsening of the pain, radiculopathy, canal stenosis, local trauma, and embolisms. Most complications are directly or indirectly related to cement injection—the most common problem being cement leakage from the vertebral body not only into the intervertebral space but also into the spinal canal. Pulmonary embolization may even occur. The present study describes the most common complications during treatment and the ways to improve the technique and procedures, with a view to avoiding such problems.