This 2014 JAAOS review examines vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures, asking whether the evidence base supports or refutes the AAOS recommendation against vertebroplasty issued after two controversial 2009 NEJM sham-controlled trials. It synthesizes eight subsequent prospective RCTs and a 2013 meta-analysis to update indications, technique comparison, complications, and cost-effectiveness.
When you see an acute osteoporotic VCF with MRI-confirmed bone edema (T2/STIR hyperintensity) and a patient who is incapacitated by pain after 3–6 weeks of nonsurgical management, cement augmentation is supported by the current evidence — but only proceed if the fracture is truly acute, as chronic fractures without edema are unlikely to respond.
If kyphoplasty is being considered over vertebroplasty purely for kyphosis correction, the 3° average improvement has no proven clinical benefit and adds substantial cost.
This 2014 JAAOS review examines vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures, asking whether the evidence base supports or refutes the AAOS recommendation against vertebroplasty issued after two controversial 2009 NEJM sham-controlled trials. It synthesizes eight subsequent prospective RCTs and a 2013 meta-analysis to update indications, technique comparison, complications, and cost-effectiveness.
When you see an acute osteoporotic VCF with MRI-confirmed bone edema (T2/STIR hyperintensity) and a patient who is incapacitated by pain after 3–6 weeks of nonsurgical management, cement augmentation is supported by the current evidence — but only proceed if the fracture is truly acute, as chronic fractures without edema are unlikely to respond.
If kyphoplasty is being considered over vertebroplasty purely for kyphosis correction, the 3° average improvement has no proven clinical benefit and adds substantial cost.