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Vertebral augmentation: an overview

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Abstract

Vertebral compression fractures (VCFs) are a common pathologic process seen in 30–50% of individuals over the age of 50 years. Historically, VCFs were first treated with nonsurgical management while vertebral augmentation was reserved for severe cases resulting in deformity or significant disability. Current treatment algorithms based on established appropriateness criteria have changed recommendations towards supporting early vertebral augmentation for the VCFs causing the most clinically difficulty and taking into account the degree of vertebral body height loss, kyphotic deformity, and the degree of clinical progression. Percutaneous vertebroplasty (PVP) involves injecting primarily polymethacrylate (PMMA) bone cement directly into the cancellous bone of the vertebral body. There is recent literature showing the effectiveness of PVP including data comparing vertebroplasty to sham treatment. Vertebroplasty evolved into balloon kyphoplasty (BKP) where a balloon is first inserted into the vertebral body to create a cavity and reduce the fracture followed by an injection of bone cement. Both PVP and BKP have been shown to be significantly more effective at treatment of VCFs compared to nonsurgical management. The benefits shown in the literature have been demonstrated randomized control trials, cohort matched trials, post-market trials, registries, and many other data sources with approximately 250 manuscripts produced per year dedicated to the topic of vertebral augmentation.

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Adapted from: Beall DP, Chambers MF Thomas SM, et al. Prospective and multicenter evaluation of outcomes for quality of life and activities of daily living for balloon kyphoplasty in the treatment of vertebral compression fractures: the EVOLVE trial. Neurosurgery. 2019; 84:169–78

Fig. 5

Adapted from: Beall DP, Chambers MF Thomas SM, et al. Prospective and multicenter evaluation of outcomes for quality of life and activities of daily living for balloon kyphoplasty in the treatment of vertebral compression fractures: the EVOLVE trial. Neurosurgery. 2019; 84:169–78

Fig. 6

Adapted from: Beall DP, Chambers MF Thomas SM, et al. Prospective and multicenter evaluation of outcomes for quality of life and activities of daily living for balloon kyphoplasty in the treatment of vertebral compression fractures: the EVOLVE trial. Neurosurgery. 2019; 84:169–78

Fig. 7

Adapted from: Beall DP, Chambers MF Thomas SM, et al. Prospective and multicenter evaluation of outcomes for quality of life and activities of daily living for balloon kyphoplasty in the treatment of vertebral compression fractures: the EVOLVE trial. Neurosurgery. 2019; 84:169–78

Fig. 8

Adapted from: Shonnard, N. H., Berven, S., Anderson, P. A., Verschuyl, E., Norwitz, J., Shonnard, N., Khor, S., Wagoner, D. D., Yoon, E. S., & Beall, D. P. (2020). Appropriate management of vertebral fragility fractures: development of a pathway based on a vertebral compression fracture registry. Pain physician, 23(4), E343–E352

Fig. 9

Adapted from: Shonnard, N. H., Berven, S., Anderson, P. A., Verschuyl, E., Norwitz, J., Shonnard, N., Khor, S., Wagoner, D. D., Yoon, E. S., & Beall, D. P. (2020). Appropriate management of vertebral fragility fractures: development of a pathway based on a vertebral compression fracture registry. Pain physician, 23(4), E343–E352

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References

  1. Ballane G, Cauley JA, Luckey MM, et al. Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int. 2017;28(5):1531–42.

    Article  CAS  PubMed  Google Scholar 

  2. Curtis JR, Taylor AJ, Matthews RS, et al. Pathologic fractures: should these be included in the epidemiologic studies of osteoporotic fractures? Osteoporos Int. 2009;20(11):1969–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Zhu RS, Kan SL, Ning GZ, Chen GZ, Cao LX, Jiang ZH, Zhang XL, Hu W. Which is the best treatment of osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty, or non-surgical treatment? A Bayesian network meta-analysis Osteoporosis Int. 2019;30(2):287–98.

    Google Scholar 

  4. Luo J, Adams MA, Dolan P. Vertebroplasty and kyphoplasty can restore normal spine mechanics following osteoporotic fracture. J Osteoporos. 2010; 729257.

  5. Beall DP, Lorio MP, Yun BM, Runa MJ, Ong KL, Warner CB. Review of vertebral augmentation: an updated meta-analysis of the effectiveness. Int J Spine Surg. 2018;12(3):295–321.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Khan M, Kushchayev SV. Percutaneous vertebral body augmentations: the state of the art. Neuroimag Clin N Am. 2020;29:495–513.

    Article  Google Scholar 

  7. Hoyt D, Urits I, Orhuru V, et al. Current concepts in the management of vertebral compression fractures. Curr Pain Headache Rep. 2020;24(5).

  8. Beall DP. Vertebral augmentation: the comprehensive guide to vertebroplasty, kyphoplasty, and implant augmentation. 2020. Internet resource.

  9. Clark W, Bird P, Gonski P, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomized, double-blind, placebo-controlled trial. Lancet. 2016;388:1408–16.

    Article  PubMed  Google Scholar 

  10. Yang EZ, Xu JG, Huang GZ, et al. Percutaneous vertebroplasty versus conservative treatment in aged patients with acute osteoporotic vertebral compression fractures. Spine. 2016;41(8):653–60.

    Article  PubMed  Google Scholar 

  11. Papanastassiou JV, Phillips FM, Meirhaeghe JV, et al. Comparing effects of kyphoplasty, vertebroplasty, and nonsurgical management in a systematic review of randomized and non-randomized controlled studies. Eur Spine J. 2012;21:1826–43.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Galibert P, Deramond H, Rosat P, LeGars D. Note pr_liminaire sur le traitement des angiomes vert_braux par vert_broplastie acrylique percutaneous (Preliminary report on the percutaneous vertebroplasty with acrylic cement as a treatment of vertebral angioma). Neurochirurgie. 1987;33:166–8.

    CAS  PubMed  Google Scholar 

  13. Denaro V, Longo UG, Maffulli N, Denaro L. Vertebroplasty and kyphoplasty. Clinical cases in mineral and bone metabolism: the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases. 2009;6(2):125–30.

    PubMed  Google Scholar 

  14. Manz D, Georgy M, Beall DP, et al. Vertebral augmentation with spinal implants: third generation vertebroplasty. Neuroradiology. 2020;62:1607–15.

    Article  PubMed  Google Scholar 

  15. Tutton SM, Pflugmacher R, Davidian M, et al. KAST study: the Kiva system as a vertebral augmentation treatment - a safety and effectiveness trial: a randomized, non-inferiority trial comparing the Kiva system with balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures. Spine. 2015;15(40):865–75.

    Article  Google Scholar 

  16. Noriega DC, Ramajo RH, Lite IS, et al. Safety and clinical performance of kyphoplasty and Spine Jack procedures in the treatment of osteoporotic vertebral compression fractures: a pilot, monocentric, investigator-initiated study. Osteoporos Int. 2016;27(6):2047–55.

    Article  CAS  PubMed  Google Scholar 

  17. Kim HJ, Yi JM, Cho HG, et al. Comparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: a prospective randomized controlled non-inferiority trial. J Bone Joint Surg Am. 2014;96:1959–66.

    Article  PubMed  Google Scholar 

  18. Bailey CS, Dvorak MF, Thomas KC, et al. Comparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial. J Neurosurg Spine. 2009;11:295–303.

    Article  PubMed  Google Scholar 

  19. Rzewuska M, Ferreira M, McLachlan AJ, et al. The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: a systematic review with meta-analysis. Eur Spine J. 2015;24:702–14.

    Article  PubMed  Google Scholar 

  20. Liu Q, Cao J, Kong JJ. Clinical effect of balloon kyphoplasty in elderly patients with multiple osteoporotic vertebral fracture. Niger J Clin Pract 2019; 22:289–92.

  21. Hirsch JA, Beall DP, Chambers MR, Andreshak TG, Brook AL, Bruel BM, Deen HG, Gerszten PC, Kreiner DS, Sansur CA, Tutton SM, van der Meer P, Stoevelaar HJ. Management of vertebral fragility fractures: a clinical care pathway developed by a multispecialty panel using the RAND/UCLA Appropriateness Method. Spine J. 2018;18(11):2152–61. https://doi.org/10.1016/j.spinee.2018.07.025 (Epub 2018 Aug 7 PMID: 30096377).

    Article  PubMed  Google Scholar 

  22. Edidin AA, Ong KL, Lau E, Kurtz SM. Morbidity and mortality after vertebral fractures: comparison of vertebral augmentation and nonoperative management in the medicare population. Spine. 2015;40(15):1228–41. https://doi.org/10.1097/BRS.0000000000000992.

    Article  PubMed  Google Scholar 

  23. Ong KL, Beall DP, Frohbergh M, et al. Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty sham trials? Osteoporos Int. 2018;29:375–83.

    Article  CAS  PubMed  Google Scholar 

  24. Hirsch JA, Chandra RV, Carter NS, Beall D, Frohbergh M, Ong K. Number needed to treat with vertebral augmentation to save a life. AJNR Am J Neuroradiol. 2020;41(1):178–82. https://doi.org/10.3174/ajnr.A6367.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Hinde K, Maingard J, Hirsch JA, Phan K, Asadi H, Chandra RV. Mortality outcomes of vertebral augmentation (vertebroplasty and/or balloon kyphoplasty) for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. Radiology. 2020;295(1):96–103. https://doi.org/10.1148/radiol.2020191294.

    Article  PubMed  Google Scholar 

  26. Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Eng J Med. 2009;361:569–79.

    Article  CAS  Google Scholar 

  27. Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Eng J Med. 2009;361:557–68.

    Article  CAS  Google Scholar 

  28. Jha RM, Yoo AJ, Hirsch AE, et al. Predictors of successful palliation of compression fractures with vertebral augmentation: single center experience of 535 cases. J Vasc Interv Radiol. 2009;20:760–8.

    Article  PubMed  Google Scholar 

  29. Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet (London, England). 2009;373(9668):1016–24. https://doi.org/10.1016/S0140-6736(09)60010-6.

    Article  PubMed  Google Scholar 

  30. Rousing R, Anderson MO, Jespersen SM, et al. Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fracture: three-months follow up in a clinical randomized study. Spine. 2009;34:134901354.

    Article  Google Scholar 

  31. Berenson J, Pflugmacher R, Jarzem P, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicenter, randomized controlled trial. Lancet Oncol. 2011;12:225–35.

    Article  PubMed  Google Scholar 

  32. Anderson PA, Froyshteter AB, Tontz WL Jr. Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures. J Bone Miner Res. 2013;28:372–82.

    Article  PubMed  Google Scholar 

  33. Yuan WH, Hsu HC, Lai KL. Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures: a meta-analysis. Medicine (Baltimore). 2016;95(31):4491.

    Article  Google Scholar 

  34. Xie L, Zhao ZG, Zhang SJ, et al. Percutaneous vertebroplasty versus conservative treatment for osteoporotic vertebral compression fractures: an updated meta-analysis of prospective randomized controlled trials. Int J Surg. 2017;47:25–32.

    Article  PubMed  Google Scholar 

  35. Clark W, Bird P, Gonski P, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomized, double-blind, placebo-controlled trial. Lancet. 2016;388:1408–16.

    Article  PubMed  Google Scholar 

  36. Rodriguez AJ, Fink HA, Mirigian L, et al. Pain, quality of life and safety outcomes of kyphoplasty for vertebral compression fractures: report of a task force of the American Society of Bone and Mineral Research. J Bone Miner Res. 2017; Sep; 32(9):1935 - 1944.

  37. Beall DP, Chambers MF Thomas SM, et al. Prospective and multicenter evaluation of outcomes for quality of life and activities of daily living for balloon kyphoplasty in the treatment of vertebral compression fractures: the EVOLVE trial. Neurosurgery. 2019; 84:169–78.

  38. Griffoni C, Lukassen JNM, Babbi L, et al. Percutaneous vertebroplasty and balloon kyphoplasty in the treatment of osteoporotic vertebral fractures: a prospective randomized comparison. Eur Spine J. 2020;29:1614–20.

    Article  CAS  PubMed  Google Scholar 

  39. Zhang L, Zhai P. A comparison of percutaneous vertebroplasty versus conservative treatment in terms of treatment effect for osteoporotic vertebral compression fractures: a meta-analysis. Surgical Innovation. 2020;27(1):19–25.

    Article  PubMed  Google Scholar 

  40. Wang C, Zhang Y, Chen W, et al. Comparison of percutaneous curved kyphoplasty and bilateral percutaneous kyphoplasty in osteoporotic vertebral compression fractures: a randomized controlled trial. BMC Musculoskelet Disord. 2021;22(588):1–9.

    Google Scholar 

  41. Zhang B, Chen G, Yang X, et al. Percutaneous kyphoplasty versus percutaneous vertebroplasty for neurologically intact osteoporotic Kummell’s disease: a systematic review and meta-analysis. Global Spine J. 2021;1-15.

  42. Láinez Ramos-Bossini AJ, López Zúñiga D, Ruiz Santiago F. Percutaneous vertebroplasty versus conservative treatment and placebo in osteoporotic vertebral fractures: meta-analysis and critical review of the literature. Eur Radiol 2021; May 7, online ahead of print.

  43. Voormolen MH, Mali WP, Lohle PN, et al. Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol. 2007 Mar;28(3):555–60.

  44. Klazen CAH, Lohle PNM, De Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression features (Vertos II) an open-label randomized trial. Lancet. 2010;376(746):1085–92.

    Article  PubMed  Google Scholar 

  45. Farrokhi MR, Alibi E, Maghami Z. Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression fractures. J Neurosurgery. 2011;14:561–9.

    Google Scholar 

  46. Chen D, An Z-Q, Song S, et al. Percutaneous vertebroplasty compared with conservative treatment in patients with chronic painful osteoporotic spinal fractures. J Clin Neurosci. 2014;21:473–7.

    Article  PubMed  Google Scholar 

  47. Hansen EJ, Simony A, Rousing R, Carreon LY, Tropp H, Andersen MO. Double blind placebo-controlled trial of percutaneous vertebroplasty (VOPE) Global Spine. 2017;6:1–6.

  48. Firanescu CE, de Vries J, Lodder P, et al. Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV): randomized sham controlled clinical trial. BMJ. 2018;361: k1551. https://doi.org/10.1136/bmj.k15.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Wardlaw , Cumming SR, Van Meirhaeghe J, et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression (FREE): a randomized controlled trial. Lancet. 2009; 373:1016–24.

  50. Boonen S, Van Meirhaeghe J, Bastian L, Cummings SR, Ranstam J, Tillman JB, Eastell R, Talmadge K, Wardlaw D. Balloon kyphoplasty for the treatment of acute vertebral compression fractures: 2-year results from a randomized trial. J Bone Miner Res. 2011;26(7):1627–37.

    Article  PubMed  Google Scholar 

  51. Berenson J, Pflugmacher R, Jarzem P, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicenter, randomized controlled trial. Lancet Oncol. 2011;12:225–35.

    Article  PubMed  Google Scholar 

  52. Hoshino M, Takahashi S, Yasuda H, et al. Balloon kyphoplasty versus conservative treatment for acute osteoporotic vertebral fractures with poor prognostic factors: Propensity score matched analysis-using data from two prospective multicenter studies. Spine. 2019; 15; 44 (2): 110 – 117.

  53. Lange A, Kasperk C, Alvares L, Sauermann S, Braun S. Survival and cost comparison of kyphoplasty and percutaneous vertebroplasty using German claims data. Spine. 2014;39:318–26.

    Article  PubMed  Google Scholar 

  54. Ong KL, Lau E, Kemner JE, Kurtz SM. Two-year cost comparison of vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: are initial surgical costs misleading? Osteoporos Int. 2012. https://doi.org/10.1007/s00198-012-2100-0.

    Article  PubMed  Google Scholar 

  55. Edidin AA, Ong KL, Lau E, Schmier JK, Kemner JE, Kurtz SM. Cost-effectiveness analysis of treatments for vertebral compression fractures. Appl Health Econ Health Policy 2012; 10 (4): 273–284. 1175–5652/12/0004–0273/$49.95/0

  56. Shonnard NH, Berven S, Anderson PA, Verschuyl E, Norwitz J, Shonnard N, Khor S, Wagoner DD, Yoon ES, Beall DP. Appropriate management of vertebral fragility fractures: development of a pathway based on a vertebral compression fracture registry. Pain Physician. 2020;23(4):E343–52.

    PubMed  Google Scholar 

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  1. Comprehensive Specialty Care, 1700 S. State St, Edmond, OK, 73013, USA

    Douglas P. Beall

  2. Clinical Radiology of Oklahoma, 1700 S. State St, Edmond, OK, 73013, USA

    Tyler R. Phillips

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Beall, D.P., Phillips, T.R. Vertebral augmentation: an overview. Skeletal Radiol 52, 1911–1920 (2023). https://doi.org/10.1007/s00256-022-04092-8

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