Resumo

MAIA, Bruno; CARVALHAIS, Pedro; SIMOES, Isabel  e  TEIXEIRA, Luis. Cimentoplastia Vertebral: As controvérsias e o futuro. Rev. Port. Ortop. Traum. [online]. 2018, vol.26, n.2, pp.127-139. ISSN 1646-2122.

Background: Vertebral compression fractures are highly prevalent and have a profound negative impact both on patients’ quality of life as well as health care costs. Kyphoplasty and vertebroplasty are two minimally invasive surgical techniques to treat this problem. Many issues remain controversial and scientific societies give contradicted recommendations. In view of this controversy we made an updated review to give an insight of the current literature. Material and methods: Based on extensive literature review we summarize the results of clinical trials, reviews and metanalysis, published between the year 2010 and 2017. We obtained a total of 384 articles, of which we analyzed 62 publications. Results: To understand the complexity of vertebral compression fractures, we first describe a biomechanical analysis about load transfer alterations of the spine and how they damage important structures leading to progressive deformities. Then we made a comparative review between kyphoplasty and vertebroplasty assessing pain, quality of life, mobility, complications and costs/benefits associated to both techniques. The popularity of these procedures has expanded to other areas. In this review, we also addressed the role of percutaneous cementoplasty in neoplasic lesions compared to radiotherapy and open surgery. Finally we describe the latest technologies used for these procedures. Discussion: Vertebroplasty and kyphoplasty have proven to be very effective in pain control and functional improvement. Kyphoplasty has the advantage to improve vertebral height and kyphotic deformities and also decreases complications associated to cement leakage. Despite being more expensive, some studies describe lower mortality rates and length of hospital stay, compared to vertebroplasty. Vertebral augmentation procedures have been associated with adjacent segment fractures due to increased stiffness and strength in cancellous bone. Neverthless, several studies have reported similar fracture rates with conservative treatments. This suggests that better pain control and physical improvement increases pressure loads through osteoporotic bone, being responsible for new fractures. Conclusion: Evolution in hardware design enables faster and safer procedures contributing to better outcomes.

Palavras-chave : Kyphoplasty; Vertebroplasty; Vertebral Fractures; Biomechanics; Methastatic Spine Disease; New Developments.

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