Vertebral augmentation: How we do it

Vertebral augmentation consists of minimally invasive techniques indicated in the treatment of vertebral compression fractures (VCFs). These compression fractures cause vertebral body height loss and consequent significant pain and are most frequently the result of osteoporosis, cancer metastasis, or trauma. The deleterious effects of VCFs often compound, as greater load-bearing stress is transferred to the remaining healthy vertebrae. Kyphoplasty, vertebroplasty, and intravertebral implants are closely related vertebral augmentation techniques that serve to relieve pain and to counter pathophysiological stress and structural degradation of the vertebral column alignment. All 3 approaches are performed percutaneously and are therefore attractive options for patients deemed to be poor candidates for open surgery. Each technique involves transpedicular needle access to the vertebral body matrix, followed by introduction of a cement-like polymer through a catheter to fill the space and provide structural fortification. Vertebroplasty involves injection of the cement material into the matrix space without any adjunctive measures. In kyphoplasty, a balloon is first introduced to expand the collapsed, fractured area with the goal of approximating the prefracture anatomy of the vertebral body and thereby spinal curvature, promptly followed by cement introduction. In intravertebral implantation procedures, a permanent jack is inserted into the vertebral body matrix and expanded craniocaudally, with the same purpose of restoring normal structure, before the matrix space is filled with cement polymer. This article provides an overview of these vertebral augmentation techniques, including pre and postprocedural considerations, with an emphasis on the technical aspects of the interventions.