Abstract

Background: More than 700,000 people suffer from vertebral compression fractures attributed to osteoporosis, metastatic disease, or trauma each year in the United States, and undergo kyphoplasty. They are typical. These often undergo kyphoplasty to treat resultant pain or new neurological deficits. Here, we present three patients who, due to significant comorbidities, underwent kyphoplasty performed in the lateral decubitus rather than the prone position.

Case Description: Three females, two with metastatic cancer and one with osteoporosis, presented with lumbar compression fractures and new accompanying pain and/or neurological deficits. Due to significant accompanying comorbidities, kyphoplasty was safely and effectively performed in all three patients utilizing the lateral decubitus rather than the prone position.

Conclusion: Although vertebral kyphoplasties are typically performed in the prone position, here, we present three patients who, due to significant comorbidities, safely and effectively underwent kyphoplasties performed in the lateral decubitus position.

Keywords: Kyphoplasty, Lateral position, Osteoporosis, Vertebral fracture

INTRODUCTION

More than 700,000 people sustain vertebral compression fractures per year in the United States. They are typically due to osteoporosis, metastatic disease/osteolytic lesions, or trauma. Kyphoplasty is typically offered to treat resultant vertebral compression fractures. For patients with significant major comorbidities, including respiratory/compromise, kyphoplasty, rather than being performed in the prone position, may alternatively be safely and effectively performed in the lateral decubitus position.

CASE REPORTS

Case 1

A 64-year-old female, following a fall, presented with bilateral L5 radiculopathy and bilateral L5 pathological vertebral compression fractures attributed to metastatic endometrial adenocarcinoma (i.e., previously managed with radiotherapy [ Figure 1 ]. As she could not tolerate the prone position, the lumbar L5 kyphoplasty was safely and effectively performed in the lateral decubitus position.

Figure 1:

Lumbar tomography in coronal view (a) and 3D reconstruction (b), lumbar MRI in T2 weighting (c), where a L3 vertebral compression fracture is observed. Lumbar tomography in axial (d) and sagittal (e) view after kyphoplasty, with the presence of hyperdensity in the body of L3 corresponding to cementation.

Case 2

A 58-year-old female with a history of colon cancer (i.e., status postradiotherapy, surgery, and a secondary diverting colostomy) presented with lumbar pain (8/10). When the X-ray, computed tomography (CT), and magnetic resonance studies revealed a pathological L3 compression fracture, she successfully underwent a kyphoplasty performed in the lateral decubitus rather than prone position [ Figures 2 and 3 ].

Figure 2:

Positioning of the patient in lateral decubitus before starting kyphoplasty. (a) Anterior view showing the presence of a colostomy, (b) posterior view, and (c) lateral view.

Figure 3:

Intraoperative fluoroscopy images, showing (a) AP X-ray with the presence of transpedicular cannulas, Subsequently, (b) lateral X-ray is observed during cement injection through the cannula in the vertebral body, Finally, (c) AP X-ray with the presence of intracorporeal cement at the end of the procedure and removal of cannulas.

Case 3

A 62-year-old female with a history of osteoporosis treated with teriparatide presented with a 4-week history of falling from a height. When the CT scan revealed a T7 vertebral fracture, she successfully underwent a kyphoplasty performed in the lateral decubitus rather than prone position [ Figure 4 ].

Figure 4:

Tomography images (a and b) and magnetic resonance imaging (c) showing vertebral fracture of T7. (d and e): Images of lateral decubitus positioning in the operating room. (f) Postoperative tomography, with the presence of cementation at T7.

DISCUSSION

More than 700,000 people suffer from vertebral compression fractures each year in the U.S., and kyphoplasty could be recommended as an early treatment for this population.[ 2 , 6 ] This procedure involves the insertion of an inflatable balloon into the bone tissue where the balloon is inflated, creating a cavity where cement will subsequently be injected.[ 1 , 6 ] In (Beall, cited by Imamideen N, 2022), kyphoplasty accomplished significantly better pain reduction versus conservative management.[ 5 ] Usually is performed on patients in the prone position.[ 3 ] In another study, kyphoplasty demonstrated a lower cement leak rate and greater frequency of restoration of vertebral body height versus vertebroplasty.[ 4 ] Reviews comparing kyphoplasty with other managements for vertebral fractures [ Table 1 ].

Table 1:

Summary table of kyphoplasty versus others management for verterbral fractures.

Advantages of kyphoplasty performed in the lateral decubitus position

Patients with significant comorbidities may safely/ effectively undergo kyphoplasty performed in the lateral decubitus versus the prone position. Advantages of this include reductions in the cardiac index/stroke volume and reduced left ventricular distention/venous return.[ 7 , 8 ] Sun et al. documented the increased safety/efficacy of the lateral decubitus position for performing vertebroplasties in obese patients with chronic obstructive pulmonary disease. [ 8 ] In our cases, in all patients with major comorbidities, three kyphoplasties were performed in the lateral position without contributing to any intraoperative/postoperative adverse events.

CONCLUSION

The lateral decubitus position proved to be a safe and effective alternative for performing three kyphoplasties in patients with significant comorbidities and resultant vertebral compression fractures.

Ethical approval

The Institutional review board approval is not required.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.

Acknowledgment

To the health authorities for their support in the management of patients in the neurosurgery service.

References

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