Vertebral Augmentation

Abstract The treatment options available for vertebral fractures (VFs) range from nonsurgical treatment (NST) to minimally invasive interventions, such as vertebral augmentation, which includes percutaneous balloon kyphoplasty (BKP) and titanium implantable vertebral augmentation devices (TIVAD). Although most VFs can be managed with NST, a subset with significant vertebral height loss, mechanical disruption, and uncontrollable pain may warrant vertebral augmentation. Vertebral augmentation using specific FDA approved devices are considered medically necessary for the treatment of symptomatic thoracolumbar osteoporotic VFs that have failed to respond to at least 6 weeks of conservative NST, and for the treatment of severe pain due to osteolytic lesions of the spine, related to malignancy. Overall, current guidelines and multiple reviews suggest that BKP is a safe and effective procedure with level I evidence recommending its use when proper criteria are met. Additionally, level I TIVAD related studies have demonstrated non-inferiority, when compared to BKP, with similar safety, efficacy, and interestingly less incidence of adjacent fractures. A poor prognostic factor is found if vertebral augmentation is not performed earlier than 6 months after injury, advocating a strategy for intervention early on. Hence, vertebral augmentation has a life changing impact in morbidity and mortality in patients with VFs, with a low NNT to save one life at 1 and 5 years. Both vertebral augmentation modalities conferred a prominent mortality benefit over NST with a low NNT, demonstrating a relative mortality advantage of BKP over NST. Since VFs have been associated with increased morbidity and mortality, and considering the abundance of high-quality information, multiple medical societies favor and confidently advocate the use of vertebral augmentation in the treatment of VFs. In summary, there is no consensus about which vertebral augmentation device is best for treating VFs. The decision to choose one vertebral augmentation system over another is physician dependent, however clinical guidelines, society recommendations and level I studies favor BKP and TIVAD, which have demonstrated similar outcomes of improved quality of life, functionality and pain relief in patients with VFs.