Vertebral augmentation techniques for the treatment of vertebral compression fractures: A review

Vertebral augmentation techniques have become enormously popular procedures in the United States and abroad for the treatment of painful vertebral compression fractures. This minimally invasive procedure avoids or mitigates the direct and indirect adverse effects of pharmacologic and conventional pain treatment modalities while providing pain relief and improved function in an expedited fashion. Vertebral augmentation procedures include percutaneous vertebroplasty, the injection of bone cement directly into a fractured vertebral body, and balloon kyphoplasty, in which an inflatable bone tamp is employed to create a cavity in the bone prior to cement injection. These procedures are performed on fractures of thoracolumbar vertebrae and the sacral vertebrae (sacroplasty). Until recently, the efficacy of vertebral augmentation procedures had been supported in numerous case reports, case series, and nonrandomized trials. Practitioners valued the procedures, and patients seemed to prefer the active intervention as opposed to medical therapy. However, the level of evidence of these early reports was fair to poor because of the lack of randomized, controlled trials. Recent prospective, randomized, and controlled trials have done little to confirm or deny the efficacy of the techniques. In general, they have found percutaneous vertebroplasty or balloon kyphoplasty either beneficial or not different compared with conservative therapy with regards to primary (pain and disability) and secondary outcome indexes (quality of life, analgesic usage, etc.). The direction of future studies should be directed at endpoints, such as short-term benefits, cost-effectiveness, and longer-term prognosis, and should include adequate sample sizes to allow stratification of patients according to history and physical findings.