Updated: Oct 21
Vertebral augmentation can be accomplished through various techniques - Dr. Venu Vadlamudi and Dr. Kumar Madassery shed light on the utility of kyphoplasty versus vertebroplasty when treating compression fractures of the spine.
The BackTable Brief
The treatment of a vertebral compression fracture with either kyphoplasty or vertebroplasty is mostly operator dependent; current literature should always be used to guide treatment.
Dr. Venu Vadlamudi prefers the use of straight vertebroplasty in his practice on the premise that studies have yet to show a significant difference in specific outcomes with other techniques.
In a compression fracture with significant height loss, Dr. Kumar Madassery opts for balloon kyphoplasty over straight vertebroplasty.
Disclaimer: The opinions expressed by the participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
Opting for Straight Vertebroplasty
Great, yeah, so I wanted to get into a little bit about technique, because I know Venu, you actually perform more vertebroplasty than kyphoplasty and I was just curious to know, how that came about. I'm just trained doing kyphoplasty. I have never actually done vertebroplasty and so I'm curious to know how you started leaving out the balloon?
Sure. During my training I did train on both but a little bit I would have to say is from looking at the literature, looking what's out there. I think in some of the meta analysis that are out there, there might be a slight advantage of kyphoplasty over vertebroplasty, but I think all in all I would say, at least my opinion is that, the data is mostly a wash. Obviously some sort of vertebral augmentation, if we kind of lump them in that more broad category, seems to work in the right patient. With the pain and the fracture, putting it all together, we know we can help these patients.
And so almost in a sense of simplicity, [in] our practice we meet quite often, we sit down and say well, as a section, “what do we want to do,” “how do we want to make services available,” etc ... and so we've looked through and looked at data that's available and said, well, maybe we should simplify things and go with the straight vertebroplasty.
And that's part of what I talk about in consultations with patients. I talk about the fact that there's these different flavors of ultimately getting cement into the bone and how much cement you get in there. Height restoration I think is something that sounds great in theory, but there has not been any hard data that shows that it actually makes a difference in specific outcomes. And so there's lots of different devices and tools and techniques, and including things that are not even available in the U.S., but I don't know that there's enough hard data to say that any of them are truly superior to vertebroplasty alone. So, that's kind of the scientific rationale that we use behind that.
Using Balloon Kyphoplasty for Significant Height Loss in the Setting of Spinal Compression Fractures
...At our place we have three different systems. Primarily we end up using two, whether its kyphoplasty or vertebroplasty, but we do have three because one is a kypho with a RFA, the other one's a vertebro with RFA and then the other one's curved. So we have all of them. Most of us who do it, we pick and choose based on the patient and then not because we think the evidence is better, but mostly so our fellows get trained at all of them since they have to go out and be the ones like yourselves who are making the choices on which one system makes sense for their practice.
So in that sense we do teach all three and my own personal choice is, if I believe the height restoration makes a difference and when I see a big height loss, I'll consider using the balloon more than the straight vertebroplasty...If I'm in the upper thoracic level and it's a big fracture, then the balloon makes more sense to me or if height loss is great, the balloon makes more sense to me. It's just operator dependent again [and] I think the outcome for us, subjectively, they're the same.
Dr. Venu Vadlamudi is a practicing interventional radiologist in Alexandria, Virginia.
Dr. Kumar Madassery is a practicing interventional radiologist with Rush University in Chicago. Dr. Aaron Fritts is a practicing interventional radiologist and founding partner of BackTable.
Cite this podcast:
BackTable, LLC (Producer). (2018, January 28). Ep 21 – Vertebral Augmentation [Audio podcast]. Retrieved from https://www.backtable.com/podcasts
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