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Spine: A. Hadjipavlou, T. Tosounidis, I. Gaitanis, K. Kakavelakis, and P. Katonis Balloon kyphoplasty as a single or as an adjunct procedure for the management of symptomatic vertebral haemangiomas J Bone Joint Surg Br 2007; 89-B: 495-502 [Abstract] [Full text] [PDF]

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Balloon kyphoplasty as part of the treatment of symptomatic vertebral hemangiomas

Peter L Munk, Raju Heran   (17 August 2007)

Balloon kyphoplasty as part of the treatment of symptomatic vertebral hemangiomas 17 August 2007
Peter L Munk, Professor & Head, MSK Division, Department of Radiology University of British Columbia, Vancouver General Hospital, Raju Heran Send letter to journal: Re: Balloon kyphoplasty as part of the treatment of symptomatic vertebral hemangiomas peter.munk{at}vch.ca Peter L Munk, et al.	Sir, We have read this article with considerable interest. As is well demonstrated in this manuscript, this is an efficacious treatment for a condition that is otherwise at times challenging to treat, and the authors are to be congratulated on the excellent clinical outcomes. We agree that percutaneous spinal augmentation procedures done with imaging guidance are often helpful in obviating the use of more invasive, potentially dangerous and more morbid procedures that have typically been employed in the past in the treatment of these lesions. As alluded to by the authors, experience has largely been limited to the use of percutaneous vertebroplasty in the treatment of hemangiomas, and indeed the initial use of vertebroplasty in 1985 was for the treatment of a hemangioma of the cervical spine.1 Although clearly kyphoplasty in skilled hands has been shown in this manuscript to allow for an excellent clinical outcome, we would suggest that the use of vertebroplasty would have provided an equally good outcome at considerably reduced expense, and in all likelihood with shorter procedural time. Over the last five years kyphoplasty has been increasingly used worldwide and has been very aggressively promoted and marketed. Marketing has stated that kyphoplasty is a safer procedure due to its purported lower incidence of cement leakage. Although cement leakage is slightly higher with vertebroplasty, usually the only cement leakages which occur are trivial and of no clinical significance.2 The literature has clearly shown that in skilled hands both vertebroplasty and kyphoplasty are equally safe and provide excellent clinical outcomes which are fundamentally similar.3 Kyphoplasty, however, uses a larger delivery system, 8 gauge or 10 gauge systems versus 11 or 13 gauge needle systems, and is from eight to twelve times as expensive. As has been pointed out by other authors, with this greatly increased expense and a safety profile that is not demonstrably different, it is difficult to justify a preference for kyphoplasty compared with vertebroplasty.3,4 The authors also correctly point out that the use of percutaneous augmentation does not exclude a combination with other therapies such as embolisation and/or surgery. This mirrors our own experience. P.L. Munk MD, CM, FRCPC, Professor, Head Musculoskeletal Section, Department of Radiology, M.K.S. Heran, MD, FRCPC, Director, Diagnostic Neuroradiology Fellowship, Division of Neuroradiology, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada. 1. Galibert P, Deramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 1987;33:166-8. 2. Heran MK, Legiehn GM, Munk PL. Current concepts and techniques in percutaneous vertebroplasty. Orthop Clin North Am 2006;37:409-34. 3. Jensen ME, McGraw JK, Cardella JF, Hirsch JA. Position statement on percutaneous vertebral augmentation: a consensus statement developed by the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, American Association of Neurological Surgeons/Congress of Neurological Surgeons, and American Society of Spine Radiology. J Vasc Interv Radiol 2007;18:325-30. 4. Mathis JM. Percutaneous vertebroplasty or kyphoplasty: which one do I choose? Skeletal Radiol 2006;35:629-31.