Recent advances in Vertebral Augmentation for the treatment of Vertebral body compression fractures

Abstract

Osteoporotic and pathologic vertebral compression fractures (VCFs) result in significant pain, reduced quality of life, and patient morbidity. Vertebral augmentation procedures (VAPs), which include vertebroplasty and kyphoplasty, have been extensively studied. Here, we review the evidence for the effectiveness of these techniques with an emphasis on recent clinical trials. There has been controversy regarding the effectiveness of VAPs in the treatment of painful VCFs. Recent high-quality clinical trials have demonstrated that with proper patient selection, which includes identification of (1) pain referable to a fracture, (2) acute or subacute fracture (less than 6 weeks), and (3) evidence of bone edema or intravertebral clefts on magnetic resonance imaging or high radiotracer uptake on bone scintigraphy, patients are highly likely to achieve significant improvements in long-term pain control and reduced pain-related disability with low procedural risk. Both vertebroplasty and kyphoplasty are effective VAPs, and no high-quality, recent study has found a substantial difference in the relative effectiveness of these techniques. VAPs are safe and effective in the management of acute, painful osteoporotic, and pathologic VCFs given appropriate clinical and imaging-based patient selection. Developing evidence suggests a role for VAPs in the management of painful chronic osteoporotic fractures, and as part of a multimodal approach toward both pain and local tumor control in patients with pathologic VCFs.