ESR Essentials: percutaneous bone consolidation-practice recommendations by the European Society of Musculoskeletal...

Percutaneous bone consolidation is increasingly used for the management of bone pain resulting from benign and malignant conditions. Percutaneous vertebroplasty was first performed in 1984 through the injection of polymethylmethacrylate (PMMA) bone cement directly into the cancellous bone of the vertebral body. Then, in the late nineties, balloon kyphoplasty was introduced consisting of the positioning of an inflatable balloon at the fracture site to create a cavity and restore the vertebral height, followed by PMMA injection. In recent years, more advanced techniques involving spinal implants combined with cement injection have also been developed in an attempt to restore vertebral body height. Vertebral augmentation techniques have been shown to be more effective for the treatment of vertebral fragility fractures than non-surgical management. Apart from osteoporotic fractures, vertebral augmentation has also demonstrated pain reduction and function improvement in patients with metastatic fractures. In extraspinal bone sites, percutaneous osteoplasty has proved helpful in treating both osteoporotic and pathological fractures, as well as in preventing tumor-related impending fractures. Recently, screw-mediated osteosynthesis has been described to withstand shear and rotational forces in the pelvic ring and long bones. We herein provide recommendations for the most common clinical situations that may benefit from such bone consolidation techniques. KEY POINTS: Vertebral augmentation is more effective for the treatment of vertebral fragility fractures than non-surgical management. Vertebral augmentation can provide pain reduction and function improvement in patients with spinal metastases. Percutaneous osteoplasty and osteosynthesis can treat osteoporotic and pathological fractures in the pelvic ring and long bones.