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Percutaneous vertebral augmentation in fragility fractures—indications and limitations

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

There is still no general consensus about the management of osteoporotic vertebral fractures. Recommendations depend on type of fracture, grade of instability, bone quality, and general conditions of the patient. Spontaneous fractures may be considered to be treated different compared to cases with high-velocity trauma.

Methods

According to the DVO, patients without trauma should first be treated conservatively. However, there is no more strict time protocol of 3 or 6 week conservative treatment before operations may be indicated. Surgical criteria are not yet distinctly defined. For highly unstable fractures (type B and C according to the AO Spine Classification), posterior instrumentation with cement augmented screws and as long construct, respectively, is adequate. Current literature has been analysed for diagnostic and therapeutic protocols.

Results

There is no clear operative concept for burst fractures and classic osteoporotic fractures with dynamic ongoing sintering. Percutaneous vertebral augmentation showed to prevent the fractures from ongoing kyphotic deformity and the patients from painful immobilization. Indications and results of classical vertebroplasty and kyphoplasty have been discussed intensively in the literature. Further development included special injection techniques, cements with different viscosities and stenting systems to reach more stable constructs and avoid typical complications, such as cement extrusion.

Conclusions

This review reports upon indications and limitations of percutaneous vertebral augmentation and the potential development of classifications and therapeutic algorithms.

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Abbreviations

ASA:

American Society of Anesthesiologists

CT:

Computed tomography

DGOU:

Deutsche Gesellschaft für Orthopädie und Unfallchirurgie

DVO:

Dachverband Osteologie

DXA:

Dual energy X-ray absorptiometry

KP:

Kyphoplasty

MRI:

Magnetic resonance imaging

OF:

Osteoporotic fracture

OVF:

Osteoporotic vertebral fractures

PMMA:

Polymethylmethacrylate

PVAS:

Percutaneous vertebral augmentation system

RCT:

Randomized controlled trial

QOL:

Quality of life

STIR:

Short-tau inversion recovery

VP:

Vertebroplasty

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Author information

Authors and Affiliations

  1. Department of Spine Surgery, BGU Trauma Center, Prof. Küntscher Str. 8, 82418, Murnau, Germany

    O. Gonschorek, S. Hauck, T. Weiß & V. Bühren

Authors
  1. O. Gonschorek
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  2. S. Hauck
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  3. T. Weiß
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  4. V. Bühren
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Corresponding author

Correspondence to O. Gonschorek.

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The authors comply with the ethical guidelines for authorship and publishing in the European Journal of Trauma and Emergency Surgery. This article does not contain any studies with human or animal subjects performed by the authors.

Conflict of interest

Oliver Gonschorek, Stefan Hauck, Thomas Weiß, and Volker Bühren declare no conflict of interest in relation to this work.

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Gonschorek, O., Hauck, S., Weiß, T. et al. Percutaneous vertebral augmentation in fragility fractures—indications and limitations. Eur J Trauma Emerg Surg 43, 9–17 (2017). https://doi.org/10.1007/s00068-016-0753-7

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  • DOI: https://doi.org/10.1007/s00068-016-0753-7

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