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Vertebral augmentation: report of the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery
  1. Ronil V Chandra1,
  2. Philip M Meyers2,
  3. Joshua A Hirsch3,
  4. Todd Abruzzo4,
  5. Clifford J Eskey5,
  6. M Shazam Hussain6,7,
  7. Seon-Kyu Lee8,
  8. Sandra Narayanan9,
  9. Ketan R Bulsara10,
  10. Chirag D Gandhi11,
  11. Huy M Do12,
  12. Charles J Prestigiacomo13,
  13. Felipe C Albuquerque14,
  14. Donald Frei15,
  15. Michael E Kelly16,
  16. William J Mack17,
  17. G Lee Pride18,
  18. Mahesh V Jayaraman19,
  19. on behalf of the Society of NeuroInterventional Surgery
  1. 1Monash Medical Centre, Melbourne, Victoria, Australia
  2. 2Department of Radiology and Neurological Surgery, Columbia University, New York, New York, USA
  3. 3Neuro Endovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
  5. 5Department of Radiology, Neurology and Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  6. 6Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
  7. 7Cleveland Heights, Ohio, USA
  8. 8Department of Radiology, The University of Chicago, Chicago, Illinois, USA
  9. 9Departments of Neurosurgery and Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
  10. 10Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
  11. 11New Jersey Medical School, Neurological Institute of New Jersey, Newark, New Jersey, USA
  12. 12Department of Radiology and Neurosurgery, Stanford University Medical Center, Stanford, California, USA
  13. 13Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
  14. 14Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  15. 15Department of Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA
  16. 16Department of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  17. 17Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
  18. 18Department of Neuroradiology, UT Southwestern, Dallas, Texas, USA
  19. 19Warren Alpert School of Medical at Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr Mahesh V Jayaraman, Warren Alpert School of Medical at Brown University, Providence, RI 2903, USA; MJayaraman{at}Lifespan.org

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Introduction

Vertebroplasty and kyphoplasty are minimally invasive image-guided procedures that involve the injection of cement (typically polymethylmethacrylate (PMMA)) into a vertebral body. Kyphoplasty involves inflation of a balloon tamp to create a cavity within the vertebral body into which cement is subsequently injected. The majority of these vertebral augmentation procedures are performed to relieve back pain from osteoporotic or cancer-related vertebral compression fractures and to reinforce the vertebral body with neoplasm or vascular tumor. The primary goal of vertebroplasty and kyphoplasty is to reduce back pain and to improve patient's functional status, and the secondary goal is stabilization of a vertebra weakened by fracture or neoplasia.

Osteoporotic vertebral fractures

Osteoporosis is a common disease that causes significant morbidity and incurs a significant healthcare cost to the community. The major osteoporotic fractures involve the hip, vertebra, proximal humerus and distal forearm; the lifetime osteoporotic fracture risk at age 50 is approximately one in two women and one in five men.1 The lifetime incidence of symptomatic osteoporotic vertebral fractures in women at age 50 is estimated at 10–15%1; once a vertebral fracture occurs, there is a 20% risk of another vertebral fracture within 12 months.2

Most osteoporotic vertebral compression fractures are asymptomatic or result in minimal pain; only a third of vertebral fractures result in medical attention.3 Conservative medical therapy is therefore appropriate for the vast majority of vertebral compression fractures since most acute back pain symptoms are mild and subside over a period of 6–8 weeks as the fracture heals. The goals of conservative therapy are pain reduction (with analgesics and/or bed rest), improvement in functional status (with orthotic devices and physical therapy) and prevention of future fractures (with vitamin D, calcium supplementation and antiresorptive agents).

However, conservative treatment for those with severe pain or limitation of function is not benign. It …

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