Pain Management/MSK

Session: Educational Exhibit Presentations - Station 12: Women's & Men's Health

Vertebral Augmentation Saves Lives

Monday, March 6, 2023

5:35 PM – 5:40 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Joseph Kus, MD

Diagnostic Radiology Resident Physician
Loyola University Medical Center

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

KM

Kyle McWilliams, DO

Interventional Radiology Fellow
Loyola University
JO

John Olivieri, Jr., MD (he/him/his)

Diagnostic Radiology Resident Physician
Loyola University Medical Center
AR

Arra Reddy, MD

Interventional Radiologist
Edward Hines, Jr. VA Hospital
JA

John Annes, MD

Interventional Radiologist
Loyola University Medical Center
AM

Angelo Malamis, MD

Interventional Radiologist
Loyola University Medical Center

Disclosure(s):

Joseph Kus, MD: No financial relationships to disclose

John Olivieri, MD, Jr.: No financial relationships to disclose

Learning Objectives:

Present a chronological, visual, and literature-based appraisal of minimally invasive vertebral augmentation (VA) techniques.

Discuss benefits and drawbacks of each vertebral augmentation method and the biomechanical support they provide.

Demonstrate the safety and efficacy of various vertebral augmentation techniques and discuss how they improve patient outcomes.

Background: Vertebral body compression fractures are a common and morbid pathology. Etiologies include trauma, osteoporosis and neoplasm, though a single fracture may be multifactorial in origin {1,2}. It is estimated that over 1.5 million occur annually, costing the healthcare system $17.5 billion and increasing the mortality risk of these patients by a factor of nine {1,3,4}.

Clinical Findings/Procedure Details: Vertebroplasty was first attempted in 1984, and has since been supplemented by the advent of balloon kyphoplasty (BKP). Decades later, implantable devices were introduced, including the Kiva implant and Spine Jack, the safety and efficacy of which were evaluated in the KAST and SAKOS trials. The KAST study showed that the Kiva implant is non-inferior to BKP in several primary and secondary endpoints, including a positive trend in adjacent level fracture {5}. The SAKOS trial showed the superiority of the Spine Jack to BKP, with better pain relief, height restoration, and rate of adjacent level fracture. Both studies demonstrated enhanced biomechanical effects {6}. Overall, these therapies have demonstrated significant improvement in vertebral height, stability, pain and mortality rates {7-10}. Work has also been done to compare the outcomes for nonsurgical management, kyphoplasty, and vertebroplasty, showing that 12 patients need to be treated with kyphoplasty to save one life and 24 with vertebroplasty {11}. Several studies have shown a mortality benefit to VA. One showed patients who underwent VA were 22% less likely to die up to 10 years after treatment {12}. Another showed that compared to kyphoplasty, patients managed non-surgically have a 55% higher adjusted risk of mortality, as well as higher risk of developing pneumonia, cardiac complications, DVT, and UTI {13}.

Conclusion and/or Teaching Points: In this educational exhibit we present a multifaceted appraisal of these minimally invasive VA techniques, offering the reader both context of the past and new directions on the horizon. We will also discuss the outcomes in patients receiving VA to those receiving nonsurgical management and show that VA resulted in a low number needed to treat to save one life and lower morbidity and mortality.