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.