[Vertebroplasty: an update: value of percutaneous cement augmentation after randomized, placebo-controlled trials]

Percutaneous cement augmentation (kyphoplasty and vertebroplasty) has become established as a procedure for treatment of painful osteoporotic vertebral fractures and certain neoplastic changes. The injection of cement ensures rapid stabilization of the vertebra and prevents further sintering. This also results in pain improvement. Nonetheless, based on two placebo-controlled trials, this treatment approach has been called into question. However, these studies did not take the technical aspects of the treatment into consideration, and it appears probable that the amount of filler material chosen was too small so that the treatment group also received placebo. Furthermore, it is likely that mostly older fractures were treated so that the effect can no longer be expected to be as pronounced. A randomized, controlled trial comparing kyphoplasty to conservative management provided good evidence that cement augmentation is of benefit within the first year. Newer procedures for kyphoplasty are very promising, but their clinical significance still needs verification.