Current Concepts in the Management of Vertebral Compression Fractures

Abstract

Despite increasing awareness of osteoporosis, fragility fractures still occur with regularity. In patients who have only mild or moderate pain, bracing and supportive care is all that is typically necessary. Surgical invention is recommended in patients who have neurologic compromise or continue to have pain and disability after a suitable period of nonoperative treatments. In most patients who do not have neurologic compromise, kyphoplasty and vertebroplasty are very good options. Both are percutaneous procedures that stabilize the fracture with polymethylmethacrylate. The results of both kyphoplasty and vertebroplasty have been very good. It has been demonstrated in multiple studies that these procedures result in immediate and sustained pain relief in most patients. Also, recovery is very quick in these patients, and patients are usually able to go home the same day or the day after surgery because they have such small incisions and blood loss is minimal. Thus, among spine surgeons and interventional radiologists, it is generally agreed that either a kyphoplasty or vertebroplasty is the procedure of choice in patients who have an osteoporotic compression fracture. For the physicians who prefer kyphoplasty, they list height restoration, improved spinal alignment, and a decreased incidence of cement leakage into the spinal canal as their reasons for choosing kyphoplasty. In those who prefer vertebroplasty, cost is the primary reason for their choice. Despite these differences, both procedures have been shown to have similar success rates with a slightly increased rate of cement leakage in the vertebroplasty group. These cement leakages, however, have not been shown to have any clinical significance.