Percutaneous cement augmentation techniques for osteoporotic spinal fractures
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REVIEW ARTICLE
Percutaneous cement augmentation techniques for osteoporotic spinal fractures L. M. Benneker • S. Hoppe
Received: 26 December 2012 / Accepted: 4 February 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Minimally invasive vertebral augmentationbased techniques have been used for the treatment of spinal fractures (osteoporotic and malignant) for approximately 25 years. In this review, we try to give an overview of the current spectrum of percutaneous augmentation techniques, safety aspects and indications. Crucial factors for success are careful patient selection, proper technique and choice of the ideal cement augmentation option. Most compression fractures present a favourable natural course, with reduction of pain and regainment of mobility after a few days to several weeks, whereas other patients experience a progressive collapse and persisting pain. In this situation, percutaneous cement augmentation is an effective treatment option with regards to pain and disability reduction, improvement of quality of life and ambulatory and pulmonary function.
effect, resulting in the progression of deformity, persisting pain and/or significant reduction of quality of life (QoL). Minimally invasive vertebral augmentation-based techniques [e.g. vertebroplasty (VP) and kyphoplasty (KP)] have been used for the treatment of spinal fractures (osteoporotic and malignant) for approximately 25 years. Previously used in open tumour surgery to refill the bony defect in the vertebral body [5], the percutaneous application of polymethylmethacrylate bone cement (PMMA) was first described by Galibert et al. for the treatment of vertebral angiomas [6]. Since then, the technique was adapted to its present form. In this review, we try to give an overview of the current spectrum of percutaneous augmentation techniques, safety aspects and indications.
Keywords Osteoporosis Spine Fractures Surgery Cement augmentation Vertebroplasty Kyphoplasty
Indications
Introduction Osteoporotic fractures of the spine affect 1.4 million people per year worldwide and are an economic burden for many health care systems [1]. Besides typical pain, they can lead to a significant reduction of physical function and increased morbidity and mortality [2–4]. In some cases, non-surgical conservative treatment has no or just minimal clinical
L. M. Benneker (&) S. Hoppe Department of Orthopaedic Surgery, Inselspital, Berne University Hospital, 3010 Berne, Switzerland e-mail: [email protected]
Most compression fractures present a favourable natural course, with reduction of pain and regainment of mobility after a few days. After the initial diagnosis of a vertebral compression fracture (VCF) we, therefore, recommend to always first try a conservative treatment with sufficient analgesia and support in mobilisation. Seven to ten days after the onset of pain, we perform a clinical and radiological control by a spine specialist to assess whether the kyphotic deformity is progressive under load and if the pain shows a mechanica
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