This article is to review the different types of vertebral augmentation implants recently becoming available for the treatment of benign and malignant spinal compression fractures. After a detailed description of the augmentation implants, we review the available clinical data. We will conclude with a summary of the advantages and disadvantages of vertebral implants and how they can affect the future treatment options of compression fractures.
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Visual analog score
Ostwestery disability score
Vertebral body stent
Yuan H, Brown C, Phillips F (2004) Osteoporotic spinal deformity: a biomechanical rationale for the clinical consequences and treatment of vertebral body compression fractures. J Spinal Disord Tech 17(3):236–242
Disch AC, Schmoelz W (2014) Cement augmentation in a thoracolumbar fracture model: reduction and stability after balloon kyphoplasty versus vertebral body stenting. Spine (Phila Pa 1976) 39:E1147–E1153
Fürderer S, Anders M, Schwindling B, Salick M, Düber C, Wenda K, Urban R, Glück M, Eysel P (2002) Vertebral body stenting. A method for repositioning and augmenting vertebral compression fractures. Orthopade 31:356–361
Diel P, Röder C, Perler G, Vordemvenne T, Scholz M, Kandziora F, Fürderer S, Eiskjaer S, Maestretti G, Rotter R, Benneker LM, Heini PF (2013) Radiographic and safety details of vertebral body stenting: results from a multicenter chart review. BMC Musculoskelet Disord 14:233
Muto M, Greco B, Setola F, Vassallo P, Ambrosanio G, Guarnieri G (2011) Vertebral body stenting system for the treatment of osteoporotic vertebral compression fracture: followup at 12 months in 20 cases. Neuroradiol J 24(04):610–619
Hartmann F, Griese M, Dietz SO, Kuhn S, Rommens PM, Gercek E (2015) Two-year results of vertebral body stenting for the treatment of traumatic incomplete burst fractures. Minim Invasive Ther Allied Technol 24(03):161–166
Klezl Z, Majeed H, Bommireddy R, John J (2011) Early results after vertebral body stenting for fractures of the anterior column of the thoracolumbar spine. Injury 42:1038–1042
Werner CM, Osterhoff G, Schlickeiser J et al (2013) Vertebral body stenting versus kyphoplasty for the treatment of osteoporotic vertebral compression fractures: a randomized trial. J Bone Joint Surg Am 95:577–584
Tutton SM, Pflugmacher R, Davidian M, Beall DP, Facchini FR, Garfin SR. (2015) KAST study: the kiva system as a vertebral augmentation treatment—a safety and effectiveness trial: a randomized, noninferiority trial comparing the kiva system with balloon kyphoplasty in treatment of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976). 15;40(12):865-875
Otten LA, Bornemnn R, Jansen TR, Kabir K, Pennekamp PH, Wirtz DC, Stuwe B, Pflugmacher R (2013) Comparison of balloon kyphoplasty with the new Kiva® VCF system for the treatment of vertebral compression fractures. Pain physician 16(5):E505–E512
Korovessis P, Vardakastanis K, Repantis T, Vitsas V (2013) Balloon kyphoplasty versus KIVA vertebral augmentation—comparison of 2 techniques for osteoporotic vertebral body fractures: a prospective randomized study. Spine (Phila Pa 1976) 38(4):292–299
Korovessis P, Vardakastanis K, Vitsas V, Syrimpeis V. (2014) Is Kiva implant advantageous to balloon kyphoplasty in treating osteolytic metastasis to the spine? Comparison of 2 percutaneous minimal invasive spine techniques: a prospective randomized controlled short-term study. Spine (Phila Pa 1976). 39(4):E231-E239
Muto M, Giurazza F, Guarnieri G, Miele V, Marcia S, Masala S, Guglielmi G (2017) Percutaneous treatment of vertebral fractures. Semin Musculoskelet Radiol 21:349–356
Vanni D, Pantalone A, Bigossi F, Pineto F, Lucantoni D, Salini V (2012) New perspective for third generation percutaneous vertebral augmentation procedures: preliminary results at 12 months. J Craniovertebr Junction Spine 3:47–51
Krüger A, Oberkircher L, Flossdorf F et al (2012) Differences in the restoration of vertebral height after treatment of osteoporotic vertebra compression fractures: cadaver study. Eur Spine J 21:1415–1419
KrügerA G, Baroud DN et al (2013) Height restoration and maintenance after treating unstable osteoporotic vertebral compression fractures by cement augmentation is dependent on the cement volume used. Clin Biomech 28(7):725–730
Krüger A, Oberkircher L, Figiel J, Floßdorf F, Bolzinger F, Noriega DC, Ruchholtz S (2015) Height restoration of osteoporotic vertebral compression fractures using different intravertebral reduction devices: a cadaveric study. Spine J 15(5):1092–1098
Jacobson RE, Nenov A, Duong HD (2019) Re-expansion of osteoporotic compression fractures using bilateral SpineJack implants: early clinical experience and biomechanical considerations. Cureus 11(4):e4572. https://doi.org/10.7759/cureus.4572
Noriega DC, Maestretti G, Renaud C, Francaviglia N, Ould-Slimane M, Queinnec S, Ekkerlein H, Hassel F, Gumpert R, Sabatier P, Huet H, Plasencia M, Theumann N, Kunsky A, Krüger A (2015) Clinical performance and safety of 108 SpineJack implantations: 1-year results of a prospective multicentre single-arm registry study. Biomed Res Int 2015:173872
Noriega DC, Ramajo RH, Lite IS, Toribio B, Corredera R, Ardura F, Krüger A (2016) Safety and clinical performance of kyphoplasty and SpineJack procedures in the treatment of osteoporotic vertebral compression fractures: a pilot, monocentric, investigator-initiated study. Osteoporos Int 27(6):2047–2055
Lin JH, Wang SH, Lin EY, Chiang YH (2016) Better height restoration, greater kyphosis correction, and fewer refractures of cemented vertebrae by using an intravertebral reduction device: a 1-year follow-up study. World Neurosurg 90:391–396
Noriega DC, Rodrίguez-Monsalve F, Ramajo R, Sánchez-Lite I, Toribio B, Ardura F. (2019) Long-term safety and clinical performance of kyphoplasty and SpineJack® procedures in the treatment of osteoporotic vertebral compression fractures: a pilot, monocentric, investigator-initiated study. Osteoporos Int 0(3):637–645, 30
Noriega DC, Marcia S, Theumann N, Blondel B, Simon A, Hassel F, Maestretti G, Petit A, Weidle PA, Mandly AG, Kaya JM, Touta A, Fuentes S, Pflugmacher R (2019) A prospective, international, randomized, noninferiority study comparing an implantable titanium vertebral augmentation device versus balloon kyphoplasty in the reduction of vertebral compression fractures (SAKOS study). Spine J 19(11):1782–1795
Meyblum L, Premat K, Elhorany M et al (2020) Safety of vertebral augmentation with cranio-caudal expansion implants in vertebral compression fractures with posterior wall protrusion. Eur Radiol 30
Verlaan JJ, van de Kraats EB, Oner FC, van Walsum T, Niessen WJ, Dhert WJ (2005) The reduction of endplate fractures during balloon vertebroplasty: a detailed radiological analysis of the treatment of burst fractures using pedicle screws, balloon vertebroplasty, and calcium phosphate cement. Spine (Phila Pa 1976) 30(16):1840–1845
Voggenreiter G (2005) Balloon kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 30(24):2806–2812
Verlaan JJ, van de Kraats EB, Oner FC, van Walsum T, Niessen WJ, Dhert WJ (2005) Bone displacement and the role of longitudinal ligaments during balloon vertebroplasty in traumatic thoracolumbar fractures. Spine (Phila Pa 1976) 30(16):1832–1839
Galzio R, Kazakova A, Pantalone A, Grillea G, Bartolo M, Salini V, Magliani V (2016) Third-generation percutaneous vertebral augmentation systems. J Spine Surg 2(1):13–20
Kerschbaumer G, Gaulin B, Ruatti S, Tonetti J, Boudissa M (2019) Clinical and radiological outcomes in thoracolumbar fractures using the SpineJack device. A prospective study of seventy-four patients with a two-point three year mean of follow-up. Int Orthop 43(12):2773–2779
Vanni D, Pantalone A, Magliani V, Salini V, Berjano P (2017) Corpectomy and expandable cage replacement versus third generation percutaneous augmentation system in case of vertebra plana: rationale and recommendations. J Spine Surg. 3(3):379–386
Cianfoni A, Distefano D, Isalberti M, Reinert M, Scarone P, Kuhlen D, Hirsch JA, Bonaldi G (2019) Stent-screw-assisted internal fixation: the SAIF technique to augment severe osteoporotic and neoplastic vertebral body fractures. J Neurointerv Surg 11(6):603–609
Venier A, Roccatagliata L, Isalberti M, Scarone P, Kuhlen DE, Reinert M, Bonaldi G, Hirsch JA, Cianfoni A (2019) Armed kyphoplasty: an indirect central canal decompression technique in burst fractures. AJNR Am J Neuroradiol 40(11):1965–1972
Anselmetti GC, Manca A, Tutton S, Chiara G, Kelekis A, Facchini FR, Russo F, Regge D, Montemurro F (2013) Percutaneous vertebral augmentation assisted by PEEK implant in painful osteolytic vertebral metastasis involving the vertebral wall: experience on 40 patients. Pain Physician 16(4):E397–E404
No funding was received for this study.
Conflict of interest
Medtronic, Spineology, Merit Medical, Johnson & Johnson, SpinTech, Imaging3, IZI, Medlantis, Techlamed, Consultant, Peterson Enterprises, Medical Metrics, Radius Pharmaceuticals, Avanos, Vertiflex, Sollis Pharmaceuticals, Simplify Medical, Stryker, Lenoss Medical, Spine BioPharma, Piramal, ReGelTec, Nanofuse, Talosix, Spinal Simplicity, Pain Theory, Spark Biomedical. Medtronic, SpinTech, Medical Metrics, Avanos, Relievant, Vertiflex, Stryker, Sollis Pharmaceuticals, Simplify Medical, Lenoss Medical, Spine BioPharma. Medtronic, Imaging3, ReGelTec, Nanofuse, Talosix, Spinal Simplicity, Pain Theory, Spark Biomedical. SpinTech, Nocimed. Artio, Sophiris, Eleven Biotherapeutics, Radius Pharmaceuticals, Flow Forward, Lenoss Medical, Spine BioPharma. Thieme, Springer, Humana. Radius Pharmaceuticals, Stryker, Medtronic, Vertiflex, Merit, Medlantis, Avanos, Piramal.
All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards
Informed consent was obtained from all individual participants included in the study.
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1. Describe different types of vertebral implants available for treatment of spinal compression fractures
2. Outline published clinical data for each implant
3. Summarize the pros and cons of this new technique, the so called third generation vertebroplasty
4. Outline future role in treatment of traumatic and malignant lesions
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Manz, D., Georgy, M., Beall, D.P. et al. Vertebral augmentation with spinal implants: third-generation vertebroplasty. Neuroradiology 62, 1607–1615 (2020). https://doi.org/10.1007/s00234-020-02516-7
- Compression fractures