Percutaneous cement augmentation for osteoporotic vertebral fractures

▪ Thoracolumbar vertebral fracture incidents usually occur secondary to a high velocity trauma in young patients and to minor trauma or spontaneously in older people. ▪ Osteoporotic vertebral fractures are the most common osteoporotic fractures and affect one-fifth of the osteoporotic population. ▪ Percutaneous fixation by 'vertebroplasty' is a tempting alternative for open surgical management of these fractures. ▪ Despite discouraging initial results of early trials for vertebroplasty, cement augmentation proved its superiority for the treatment of symptomatic osteoporotic vertebral fracture when compared with optimal medical treatment. ▪ Early intervention is also gaining ground recently. ▪ Kyphoplasty has the advantage over vertebroplasty of reducing kyphosis and cement leak. ▪ Stentoplasty, a new variant of cement augmentation, is also showing promising outcomes. ▪ In this review, we describe the additional techniques of cement augmentation, stressing the important aspects for success, and recommend a thorough evaluation of thoracolumbar fractures in osteoporotic patients to select eligible patients that will benefit the most from percutaneous augmentation. A detailed treatment algorithm is then proposed.