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Percutaneous Vertebral Augmentation vs. Percutaneous Vertebroplasty

what is percutaneous vertebroplasty?

ln vertebroplasty, the material is placed directly into the fracture site to attempt to stabilize the site.  This procedure may involve no manipulation or only external reduction by extension, i.e., physical manipulation of the patient when placing the patient on the operating table before the material is injected into the fracture site.

Percutaneous vertebroplasty describes a procedure in which a sterile biomaterial such as methyl methacrylate is injected from one side or both sides into the damaged vertebral body to act as a bone cement to reinforce the fractured or collapsed vertebra.

ln a vertebroplasty procedure, a bone biopsy needle is directed into the anterior third of the vertebral body and cement is injected until the material reaches the posterior fourth of the vertebral body.

What is percutaneous vertebral augmentation?

Kyphoplasty is so named because it involves the attempt to reduce the kyphosis that results from vertebral body collapse. ln kyphoplasty, a surgical instrument is used to reduce the collapsed vertebral body towards its original shape.  The material is then placed in the vertebral body and the instrument removed, leaving the material in place to stabilize the reduction.

Vertebral augmentation is the act of cavity creation with fracture reduction along with the attempt to restore vertebral body height and alignment. Balloon catheters, called “tamps” are inserted into the vertebra and inflated. The tamp creates a void in the soft trabecular bone and restore vertebral alignment. The balloon is removed and cement is injected.

The procedures described by codes 22523 – 22525 are performed under either local or general anesthesia and involve percutaneous access into the vertebral body by introduction of a working cannula.  This is followed by the insertion of a mechanical device (e.9., expandable jack, curved tamp, expandable balloon) containing radiopaque dye to create a cavity or void, reduce the end plate fractures (i.e., restore the height, elevate the collapsed end plates), and restore overall spinal alignment from within the vertebral body.  The final step involves the vertebral body augmentation and internal stabilization by introducing or filling the resultant cavity with bone graft, enhanced bone graft slurries, allograft bone, polymethyl-methacrylate, or bone graft substitute at the physician’s discretion.

This procedure (kyphoplasty) involves placing a narrow tube that creates a path through the back into the fracture area through the pedicle of the involved vertebrae under general anesthesia. A balloon or other device such as a bone tamp is inserted through the cannula and inflated, leaving a cavity into which a cement-like material (polymethylmethacrylate) is introduced. The goal is that by inflating the balloon, the height of the vertebrae will be at least partially reestablished.

How are vertebroplasty and vertebral augmentation different?

The vertebral augmentation procedure differs from vertebroplasty in that it creates a cavity and it has the added advantage of attempting to restore vertebral body height. ln contrast to just using a small bone biopsy needle to inject cement like vertebroplasty, the following are sequentially placed needle, a guidewire, cannula and a drill. At this point the mechanical cavity creation device is placed. The mechanical cavity creation fracture reduction device is gradually deployed to create a cavity. This cavity creation device is not the needle, cannula or drill. When this device is removed, it leaves a well formed cavity ready to receive injected cement.

A cavity or void must be created prior to the injection of cement to report vertebral augmentation.

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