Vertebroplasty, Kyphoplasty, and Sacroplasty

Vertebral compression fractures (VCFs) are common and are an increasing health issue worldwide that can cause significant pain and disability. Most of these fractures are osteoporotic but they can also be caused by trauma or metastatic disease. Appropriate recognition and treatment of these fractures is based upon clinical symptoms and imaging appearance, but they have been traditionally underrecognized and undertreated. The treatment of VCFs is typically by vertebral augmentation which can be done with either fluoroscopic or computed tomography guidance. Vertebral augmentation includes a number of techniques for treating VCFs including vertebroplasty, balloon or mechanical device kyphoplasty, and implant augmentation. All of the techniques aim to stabilize the vertebral body and the later generation techniques also focus on restoring vertebral body height. The indications and contraindications for treating VCFs are best defined by expert recommendation appropriateness criteria that were produced using established methodology. These recommendations support treatment of VCFs based only on clinical symptoms and imaging appearance, not on the age of the fracture. Additional treatment considerations include the assessment of the safety of nonsurgical management (NSM) as this is known to be associated with substantial risks. The contraindications should also be considered and separated into absolute and relative contraindications as there are very few absolute contraindications. There is strong literature support for the different types of augmentation and the outcomes have improved over time with new vertebral augmentation techniques. Along with this improvement in fracture treatment there should be a shift toward comprehensive patient treatment that involves the treatment of their underlying disorder that produced the fracture as well as the fracture itself. Based on the data that already exists, this comprehensive approach should have a significant effect on improving and extending patients’ lives.