Srujan Kancharla

Introduction. Osteoporosis is a bone disease that occurs when the body loses too much bone, cannot make enough of it or both⁸. Vacuum-like cavities are created due to the overactivity of osteoclasts that break down the bone, causing the pt to be increasingly more susceptible to bone fractures^6,7. Common fractures occur in weight bearing areas, specifically vertebral bodies and treatment for this is typically through pharmacological methods^1,10. However, in cases where vertebral compression fractures are refractory to medication¹, surgical methods are introduced: sham procedures, vertebroplasty and kyphoplasty. Sham procedures are when a surgeon exposes the vertebral body and anesthetizes the free nerve endings, whereas vertebroplasty and balloon kyphoplasty do the same but also fills the vertebral cavity with cement, polymethylmethacrylate. Balloon kyphoplasty fills the cavity by ballooning the space for the cement to fill. Methods. Each surgical procedure, such sham procedure and vertebroplasty and kyphoplasty were compared amongst each other. Kyphoplasty and vertebroplasty were first compared with sham procedures to outline the effectiveness of the method in comparison to the control and then they were compared amongst each other. Results. In terms of pain reduction, vertebroplasty and kyphoplasty did not differ significantly from sham procedures^4,5.  Vertebroplasty is useful for restoring the vertebral body’s structure and kyphoplasty was useful in restoring the vertebral body’s height. In comparison of vertebroplasty and kyphoplasty, vertebroplasty required less intraoperative time, less blood loss and less radiation exposure³. Cement leakage from vertebroplasty and kyphoplasty is a major problem not applicable to sham procedures⁹. Despite surgical treatment, there is continued refracture rates due to the pathology of osteoporosis. Discussion. For immediate pain relief, surgical procedures are the best treatment option, but they are good for about a year. Sham procedures conjoined with natural healing is good for short term, but the other two surgical procedures are better for refractory conditions. Though vertebroplasty has better clinical outcome than kyphoplasty, kyphoplasty is shown to be better in terms of holding vertebral height and structure^2,11. More clinical research is required more assessing what should be the gold standard for vertebral compression fractures. More clinical research is required more assessing what should be the gold standard for vertebral compression fractures.

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