S. Bobo Tanner MD
Divisions of Rheumatology, Allergy, & Immunology
Vanderbilt University Medical Center
Nashville, TN 

Summary Points

• Vertebroplasty and kyphoplasty are procedures to treat the pain associated with vertebral compression fracture due to osteoporosis.

• Vertebroplasty involves injecting polymethylmethacrylate (PMMA) into the involved vertebral body under pressure.

• Kyphoplasty involves initially inserting an inflatable balloon to expand the vertebral body, then removing it, and injecting PMMA into the cavity.

Introduction

Back pain is a remarkably common complaint among patients, with a lifetime prevalence greater than 70% in industrialized countries (1). Although most of the acute back pain seen by primary care physicians resolves without sequella, some of it continues as chronic back pain. For this reason, it is important that physicians know about treatable forms of back pain and recognize when these treatments are appropriate. The example here is the acute and chronic midline back pain due to a vertebral compression fracture (VCF), which, in turn, is often due to osteoporosis (1,2). Thus, it is incumbent that physicians consider osteoporosis and vertebral compression fractures in the evaluation and treatment of patients with back pain. 

A relatively new opportunity exists now to use subcutaneous procedures to stabilize these fractures, reduce the pain, and, in the case of kyphoplasty, restore height to the vertebral body. With the advent of vertebroplasty and kyphoplasty, patients can undergo treatment with a minimally invasive technique. In order to better understand the patients who are candidates for these techniques, it is important to recognize the underlying osteoporosis that accompanies many of these fractures as well as the associated fracture pain and the specific technical aspects of these procedures. In addition, it is important to realize the efficacy and side effect rates have been reported. From this information we can better judge which patients to select and what the future holds for these procedures.