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Vertebroplasty Or Kyphoplasty: Which Procedure Is Right For Your Patients?
The treatment of osteoporotic compression fractures has been bolstered with two relatively new procedures, vertebroplasty and kyphoplasty. Both procedures offer potential benefit with acceptable safety when performed by qualified physicians. The dilemma is which procedure to choose.
Vertebroplasty was first performed in France where interventional neuroradiologist Dr. Herve Deramond found it useful in treating patients with vertebral fractures resulting from benign and malignant tumors as well as osteoporotic compression fractures. Kyphoplasty was developed by orthopedic surgeon Dr. Mark Reiley with the idea to treat a vertebral compression fracture with an inflatable balloon in order to restore height to the collapsed vertebra.
All published investigations of vertebroplasty to date have shown favorable results of pain relief and restoration of activities of daily living. There is a lesser amount of literature judging the safety and efficacy of kyphoplasty, but the published data do show pain relief to be similar to that of vertebroplasty. However, reported height restoration is minimal, 3 mm on average.
While most physicians would agree that both vertebroplasty and kyphoplasty relieve the pain associated with vertebral compression fractures, there is a substantial difference in the cost of the techniques. Kyphoplasty kits are approximately $3400 while a vertebroplasty kit is around $400. Furthermore, kyphoplasty is usually performed in the operating room under general anesthesia while vertebroplasty is usually performed in the interventional radiology suite with intravenous sedation. These factors combine to make kyphoplasty 10 to 20 times more expensive than vertebroplasty (Mathis JM, et al. Am J Neuroradiol 2004; 25: 840-845).
In determining which procedure is right for which patient, it should be noted that both will relieve pain and can be performed with a low risk for complications. Given the significant differences in cost, kyphoplasty is perhaps best reserved for those select patients in whom restoration of height is feasible and beneficial. For the vast majority of patients, however, vertebroplasty will likely be the preferable option. For vertebroplasty consultations, please call Special Procedures at (847) 618-5890.
Sagittal T1-weighted MR image shows compression fractures of the L2 and L3 vertebral bodies. The dark signal within these two segments indicates that the fractures are acute.
Lateral fluoroscopic image obtained during vertebroplasty. Bone cement (bright white material) has already been injected into L3, with the instruments (white rods) now positioned within L2 in preparation for cement injection at this level.
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MR Imaging Of Adnexal Lesions: Prime Time Has Arrived
MR imaging of the female pelvis is not a new technique, with the literature of the past 15 years having hundreds of published studies supporting its usefulness in characterizing adnexal lesions. In particular, MR imaging has a very high specificity for the diagnosis of dermoid tumors and endometriomas, and it can easily differentiate pedunculated uterine leiomyomas from primary ovarian masses. Despite this proven track record, female pelvic MR imaging is an underutilized examination. While sonography is and will likely remain the mainstay of female pelvic imaging, MR imaging is a important problem-solving modality and, in certain circumstances, will allow for better and more efficient management of patients with adnexal abnormalities.
When sonography reveals a simple adnexal cyst, no further imaging is required. However, when sonography identifies an indeterminate or frankly suspicious adnexal lesion, MR imaging can be extremely valuable in patient triage. MR imaging can help decide which patients can be managed by follow-up imaging and which need surgery. For the surgical cases, MR imaging can help determine if a laparoscopic or open procedure is more appropriate. Furthermore, for highly suspicious lesions identified at MR imaging, the decision to refer to a gynecologic oncologist can be made preoperatively.
By classifying sonographically indeterminate lesions as benign, MR imaging is cost-effective, as the MR study and any recommended follow-up sonograms are less expensive than surgery. Additionally, surgical patients can be better prepared for what is expected to be found intraoperatively. This can alleviate patient anxiety and, perhaps more importantly, prevent the delivery of unexpected bad news in the recovery room.
Endovaginal sonogram reveals an indeterminate complex cystic and solid right adnexal mass. The sonographic appearance is compatible with both benign (eg, dermoid tumor, endometrioma) and malignant (eg, ovarian carcinoma) lesions.
Axial T1-weighted fat suppressed MR image shows markedly high signal within this lesion, which can only represent blood. Therefore, the lesion is an endometrioma, and it was subsequently resected laparoscopically. By giving the patient and her physician this information preoperatively, she was spared considerable anxiety as well as a potentially more invasive surgical procedure.
Thanks to Dr. Kenneth Spero for the information on vertebroplasty and kyphoplasty.
For more information about Northwest Radiology Associates, the services we provide and how to contact individual radiologists, please visit our web site: northwestradiologyassociates.com. We also welcome your questions and comments.
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