Minimally invasive treatments for osteoporotic vertebral compression fracture: Current concepts and state-of-the-art technologies

Abstract

Osteoporotic vertebral compression fractures (VCFs) are common in the elderly and can result in debilitating pain, loss of function, kyphosis with resulting height loss, and reductions in quality of life. Conservative treatment of VCFs is considered the gold standard but has limited effectiveness after the initial 23-week period when the majority of uncomplicated VCFs resolve. Surgical intervention is invasive and associated with morbidity, particularly in the elderly patient with poor bone quality. Percutaneous techniques such as vertebroplasty and vertebral augmentation have revolutionized the treatment of VCFs by filling the treatment gap between conservative care and surgery. A robust series of randomized controlled trials and case series have demonstrated effective pain reduction, function improvement, and acceptable safety with these procedures. However, limitations still exist with these techniques including the need for bipedicular access, inadequate vertebral height restoration, trabecular destruction with balloon-based techniques, inability to precisely control cement delivery, and significant radiation exposure to patients and physicians. New technologies are emerging that retain the clinical advantages of traditional percutaneous vertebroplasty and vertebral augmentation while minimizing these limitations. This review article discusses the history of minimally invasive VCF treatment, summarizes clinical evidence with these therapies, and highlights the most innovative experimental and commercial technologies available today.