Mechanical augmentation for vertebral compression fractures: A scoping review

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Radiology

Background:

• Vertebral compression fractures (VCFs) cause significant pain, disability, and healthcare costs.
• Traditional vertebroplasty and balloon kyphoplasty (KP) face limitations like cement leakage and poor vertebral height restoration.
• Mechanical vertebral augmentation (MVA) techniques aim to enhance alignment and cement containment, but comparative data are limited.

Purpose of the Study:

• To systematically review and synthesize evidence comparing MVA with KP or vertebroplasty.
• To evaluate outcomes across seven domains: cement extravasation, alignment, pain, disability, morbidity, mortality, and feasibility in complex fractures.

Main Methods:

• A comprehensive literature search was conducted across MEDLINE, Embase, and Web of Science.
• Scoping review methodology was employed, with data charted and synthesized descriptively.
• Forest plots were used to visualize outcome distributions across 52 included studies.

Main Results:

• MVA showed a trend toward reduced cement extravasation compared to KP, though definitions varied.
• Vertebral height restoration and alignment correction were often superior with MVA, but clinical significance is uncertain.
• Improved structural correction with MVA did not consistently yield better clinical outcomes; adjacent fracture rates varied.

Conclusions:

• MVA appears feasible and safe for VCFs, including complex cases.
• Radiographic improvements with MVA do not consistently translate to superior clinical outcomes.
• High-quality randomized trials are needed to clarify comparative effectiveness and long-term benefits of MVA versus other augmentation techniques.