Spinal augmentation for vertebral body fractures in the elderly population

Osteoporotic vertebral body fractures (OVBFs) are a highly prevalent pathology in the United States elderly population and can result in height loss and kyphotic deformity. While minimally invasive surgical techniques such as percutaneous kyphoplasty (PKP) and vertebroplasty (PVP) are commonly used, the efficacy of these techniques in older individuals is unknown. By examining the current body of evidence, we aim to assess the efficacy of these procedures within the context of appropriate grading of levels of evidence. This narrative review was conducted by searching multiple databases, including articles pertaining to vertebral augmentation procedures in elderly patients. Articles were then graded for levels of evidence, as outlined by the Oxford Centre for Evidence-Based Medicine (OCEBM). Literature suggests that both procedures are generally safe in advanced-age patients, can reliably and sustainably decrease pain, and may be augmented with a multitude of adjunctive/perioperative care options. Such efforts include pedicle screw fixation with or without fusion, intraoperative lidocaine injection, erector spinae plane block, and rehabilitation efforts, in addition to the use of dexmedetomidine or the combined use of remimazolam besylate and sufentanil analgesics. The most dreaded complications of both procedures are bone cement extravasation and refracture, which likely occur more frequently after PKP. Both procedures have demonstrated efficacy in the domain of anatomical correction. PKP and PVP appear to safely restore quality of life in elderly patients, yet the finer details of each procedure must be explored with higher levels of evidence to account for potential differences in complication profiles and care options.