Vertebral augmentation in osteoporosis and bone metastasis.

PURPOSE OF REVIEW: Osteoporosis is a disorder characterized by decreased bone density, disruption of trabecular architecture, and increased susceptibility to fractures. There are approximately 700,000 vertebral body compression fractures in the United States each year with approximately 70,000 of these resulting in hospitalization, with an average hospital stay per patient of eight days. Osteolytic lesions of the spine are also a growing problem, affecting as many as 70% of patients with metastatic disease or multiple myeloma. Tumor-induced osteolysis may lead to pain, dysfunction, and ultimately vertebral collapse. If left untreated, vertebral body compression fractures occur with progressive kyphosis over multiple levels, cord compromise, and intractable pain. The purpose of this review is to discuss recent advances in percutaneous minimally invasive vertebral augmentation techniques used in the treatment of compression fractures.

RECENT FINDINGS: Recent data have shown that outcomes in patients with vertebral compression fractures have been encouraging. Several studies have demonstrated the positive effects of vertebral augmentation on restoration of vertebral height and sagittal alignment. There is more evidence on the relationship between vertebral augmentation and adjacent segment vertebral compression fractures. A large series demonstrated promising results in patients with metastases and multiple myeloma.

SUMMARY: More studies are needed to assess the long-term effectiveness of early vertebral augmentation in the treatment of compression fractures. Early vertebral augmentation has, however, shown excellent early pain relief in those with severe pain or progressive collapse, up to a period of two years after its implementation.