Practice Patterns of Percutaneous Vertebroplasty: A Survey of Neurosurgeons.

Abstract

Abstract: AIM: To characterize current vertebral augmentation practices among neurosurgeons in Türkiye, with particular emphasis on patient selection, procedural approaches, complication experience, and postprocedure osteoporosis management. MATERIAL and METHODS: A national, cross-sectional, anonymous, web-based survey was conducted among neurosurgeons practicing in Türkiye. Data on clinician and institutional characteristics, indications and timing for vertebral augmentation, technical preferences, perceived complications, and approaches to secondary fracture prevention were collected using a questionnaire. Data were analyzed descriptively. RESULTS: Most respondents reported routinely performing vertebral augmentation at their centers, and many indicated substantial cumulative procedural experience. Clinical decision-making was primarily guided by pain severity and MRI-based fracture acuity. Support for vertebroplasty or kyphoplasty was highest for acute or subacute painful osteoporotic fractures refractory to conservative treatment. In contrast, support was lower for patients with chronic and traumatic fractures without neurologic deficit. Technical practice was relatively uniform, most commonly involving unilateral transpedicular access, local anesthesia with sedation, and single C-arm fluoroscopy. Cement leakage and adjacent-level fractures were frequently reported as lifetime experiences. Only a small minority of respondents reported having a written postprocedure osteoporosis protocol, and routine use of antiresorptive or anabolic therapy was limited. CONCLUSION: Vertebral augmentation is widely used by neurosurgeons in Türkiye in a selective, patient-centered manner. Although technical practice is relatively consistent, structured secondary fracture prevention after vertebral augmentation is uncommon, highlighting an important opportunity to improve long-term outcomes.