[Treatment of osteoporotic fractures. A new approach by vertebroplasty and kyphoplasty].

Osteoporosis is a systemic disease and results in progressive bone mineral loss and concurrent change in bone architecture that leave bone vulnerable to fracture. In one third of patients with acute vertebral fracture, severe pain and limited mobility persist despite appropriate nonoperative management. Vertebroplasty is a minimally invasive method that involved the percutaneous injection of cement into a collapsed vertebral body to stabilize the fractured vertebra. The indication of this technique is a painful fracture after 8 weeks of conservative treatment. Contraindications include coagulopathy, absence of facilities to perform emergency decompressive surgery, a vertebral collapse greater than 65 % and a fracture of the vertebra posterior wall. The procedure results in quick, effective pain relief and complications as epidural leakage or thermal necrosis by cement extravasation are rare. Vertebroplasty does not expand the collapsed vertebra. Kyphoplasty is a modification of this first technique and offers potential advantages as lower risk of cement extravasation and better restoration of the vertebral body height. A cannula is introduced into the vertebral body via a transpedicular approach like for the vertebroplasty technique but it is followed by insertion of an inflatable bone tamp, which when deployed reduces partially the compression fracture. This then creates a cavity to be filled with bone cement. Considering the higher rates of morbidity or mortality that is associated with osteoporotic fractures, early mobilization in these patients is of prime importance and can be achieved by using each of this two techniques with a relative low complication rate.