Vertebral augmentation in the treatment of vertebral compression fractures: review and new insights from recent studies.

Vertebral compression fractures (VCF) due to osteoporotic degeneration and metastatic disease represent an increasingly significant public health problem. Percutaneous vertebroplasty (VP) began as a simple, low-cost procedure that aimed to provide pain relief for patients with VCF. Balloon kyphoplasty (KP) was introduced later, and was presented not only as a "pain killer," but also as a deformity correction procedure. The preponderance of evidence has shown that vertebral augmentation provides significant and sustained clinical benefit for patients with VCF. The debate raised by studies published in the New England Journal of Medicine comparing VP with a sham procedure highlights the importance of very careful patient selection for vertebral augmentation procedures, since osteoporotic VCF is usually a self-limiting condition. However, vertebral augmentation may be beneficial in patients with comorbidities that make prolonged bed rest dangerous, in patients with fractures that fail to heal, and in patients with painful VCF due to metastatic disease. Patient selection should be based on a combination of clinical and radiological indications. We review recent studies in the extensive literature on vertebral augmentation, with the goal of clarifying some of the controversy surrounding these procedures.