May-June 2016

Spine Augmentation

Orlando Ortiz

Guest Editor Orlando Ortiz

A lot has happened, and not much has happened, in the field of vertebral augmentation since 1984, when a small team of doctors decided to treat a painful hemangioma of the C2 vertebra via a transoral route by placing a bone needle within the lesion and injecting radiopaque acrylic bone cement under fluoroscopic guidance. It was not until just under a decade later that this technology underwent transatlantic dissemination and was initially utilized not for tumors of the spine but for the treatment of painful osteoporotic vertebral compression fractures.1 The anecdotal case reports and case series were strikingly favorable, and the ability of interventionally-inclined radiologists to learn readily and adopt this technology into their practices led to the rapid proliferation of the vertebroplasty procedure. Not long after, in the late 1990s, technological innovation led to development of an inflatable balloon tamp that could be used in an attempt to improve patient outcomes by generating a better treatment effect beyond pain relief, specifically, height restoration and kyphosis correction, and by potentially decreasing the chances of procedure-related cement extravasation via the mechanism of cavity creation.2 This technology appealed to many operators, spine surgeons in particular, and the kyphoplasty procedure developed its identity and its own CPT code. A tremendous dialogue and debate ensued between vertebroplasty proponents and kyphoplasty advocates as to which of these procedures was “better”.3  It was at this moment that two randomized controlled trials poured a bucket of … more »