INDICATIONS:

Absolute:
1. Painful osteolytic metastatic lesion with intact posterior vertebral cortex.
2. Chronic (6-12 weeks) compression fracture with non-union.
3. Progressive kyphosis to >20° in a subacute (< 3 months) compression fracture.
4. Early vertebroplasty can be offered to patients unable to ambulate as a result of pain.

Relative:
1. Subacute (4-12 weeks) compression fracture with persistent pain despite adequate non-surgical management in ambulatory patients.
2. Acute compression fracture with > 20-30° kyphosis or > 40° collapse.
3. Acute compression fracture with one or more prior compression fractures and kyphotic deformity.
4. Patient should be informed that no long term data is available in treatment of benign pathology.
5. Chronic fractures with radiological signs of non-union.
6. ? at end of long posterior constructs.

CONTRA-INDICATIONS:

Absolute:
1. Fractures or neoplasms with spinal canal compromise.
2. Vertebra plana (complete vertebral body collapse).
3. Active local spinal infection.
4. Pregnancy

Relative:
1. Fractures and metastatic vertebrae with posterior vertebral cortex involvement.
2. Fracture in a patient with radicular symptoms.
3. Neurological symptoms.
4. Less than one third vertebral body remaining inferior to pedicle.
5. Prophylactic use is not indicated except for occasional use at the end of a long spinal construct.
7. High velocity fractures, especially in younger individuals.
8. Allergy to devices and contrast medium.
9. Bleeding disorder.

KYPHOPLASTY:

Indications:

1. It would appear that there is not a major difference in outcome if the procedure is compared with vertebroplasty.
2. Fracture reduction can be achieved with kyphoplasty but it is not certain whether it affects the clinical outcome.
3. Kyphoplasty needs to be performed under G.A. : is therefore not indicated in frail patients.
4. There might be a lower risk of neurological- and pulmonary complications due to lower pressure needed for injection and higher viscosity cement that can be used.
5. Reduction of the kyphotic angle may reduce the chance of a new fracture at an adjacent level.
6. Rate of cement leakage in treatment of osteolytic metastases is higher than in cases with osteoporotic fractures - ? rather use kyphoplasty in these cases.

Contra-indications to Vertebroplasty

Absolute contraindications
Any form of Sepsis Epidural abscess, Osteomyelitis, Discitis, etc.
Uncorrectable coagulopathy - warfarin, heparin, etc
Trauma - Symptomatic spinal-cord compression at the level of the fracture.

- Unstable fractures or Fractured pedicles.

Pain unrelated to vertebral collapse.
Degenerative spinal disorders.
Solid tumours.
Severe cardiopulmonary disease.
Pregnancy.
Lack of surgical back up or patient monitoring facilities.

Relative contraindications

Inability of the patient to lie prone for the duration of the procedure.
Acute burst fractures.Complete loss of vertebral height (vertebra plana).
Use caution in patients <40 years of age, due to unknown natural history of polymethylmethacrylate in younger patients.