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Percutaneous vertebral augmentation in fragility fractures—indications and limitations

  • O. GonschorekEmail author
  • S. Hauck
  • T. Weiß
  • V. Bühren
Original Article

Abstract

Introduction

There is still no general consensus about the management of osteoporotic vertebral fractures. Recommendations depend on type of fracture, grade of instability, bone quality, and general conditions of the patient. Spontaneous fractures may be considered to be treated different compared to cases with high-velocity trauma.

Methods

According to the DVO, patients without trauma should first be treated conservatively. However, there is no more strict time protocol of 3 or 6 week conservative treatment before operations may be indicated. Surgical criteria are not yet distinctly defined. For highly unstable fractures (type B and C according to the AO Spine Classification), posterior instrumentation with cement augmented screws and as long construct, respectively, is adequate. Current literature has been analysed for diagnostic and therapeutic protocols.

Results

There is no clear operative concept for burst fractures and classic osteoporotic fractures with dynamic ongoing sintering. Percutaneous vertebral augmentation showed to prevent the fractures from ongoing kyphotic deformity and the patients from painful immobilization. Indications and results of classical vertebroplasty and kyphoplasty have been discussed intensively in the literature. Further development included special injection techniques, cements with different viscosities and stenting systems to reach more stable constructs and avoid typical complications, such as cement extrusion.

Conclusions

This review reports upon indications and limitations of percutaneous vertebral augmentation and the potential development of classifications and therapeutic algorithms.

Keywords

Osteoporotic fracture Cement augmentation Thoracolumbar spine Percutaneous technique Kyphoplasty Vertebroplasty 

Abbreviations

ASA

American Society of Anesthesiologists

CT

Computed tomography

DGOU

Deutsche Gesellschaft für Orthopädie und Unfallchirurgie

DVO

Dachverband Osteologie

DXA

Dual energy X-ray absorptiometry

KP

Kyphoplasty

MRI

Magnetic resonance imaging

OF

Osteoporotic fracture

OVF

Osteoporotic vertebral fractures

PMMA

Polymethylmethacrylate

PVAS

Percutaneous vertebral augmentation system

RCT

Randomized controlled trial

QOL

Quality of life

STIR

Short-tau inversion recovery

VP

Vertebroplasty

Notes

Compliance with ethical standards

The authors comply with the ethical guidelines for authorship and publishing in the European Journal of Trauma and Emergency Surgery. This article does not contain any studies with human or animal subjects performed by the authors.

Conflict of interest

Oliver Gonschorek, Stefan Hauck, Thomas Weiß, and Volker Bühren declare no conflict of interest in relation to this work.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Spine SurgeryBGU Trauma CenterMurnauGermany

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