Higher incidence of new vertebral fractures following percutaneous vertebroplasty and kyphoplasty--fact or fiction?

New vertebral fractures after percutaneous vertebroplasty or kyphoplasty are said to result from biomechanical changes induced by cementation. Fact or fiction? The reported incidences for new vertebral fractures after cementation or after conservative therapy vary widely. This is mainly due to differences in their design, more specifically as to the duration of followup. Therefore a systematic review of the literature was performed, searching for comparable publications to assess the potential risk of new vertebral fractures following vertebroplasty and kyphoplasty versus conservative treatment. Studies were only included if they granted a standardized one-year radiological follow-up, so improving comparability. However, a high degree of heterogeneity was still seen among the results, which made it impossible to state that cement augmentation is as safe as conservative treatment with respect to new fractures. In other words, it was impossible to separate facts from fiction with the studies available to-day. The combined odds ratio of vertebroplasty and kyphoplasty versus conservative treatment, namely 0.96, gave a hint that there might be little difference. Large scale randomized studies will be necessary.