Purpose of review: To review the current status of vertebral augmentation procedures (VAPs) in the management of symptomatic vertebral compression fractures (VCFs) in cancer patients.
Recent findings: The natural history of VCFs in the cancer setting is presumably different from the one seen with osteoporotic fractures. Factors contributing to the poor outcome with conservative treatment in cancer patients include continued bone loss due to tumor invasion, poor nutritional status, immobilization, prolonged steroid use, gonadal ablation, chemotherapy and radiotherapy. VAPs have been shown by retrospective and prospective randomized studies to be effective in treating symptomatic VCFs. Advantages of VAPs include immediate pain relief, avoiding delays in chemoradiation, outpatient care in the majority of cases, biopsy, vertebral height restoration, and potential antitumor effect of bone cement. Results from the prospective randomized Cancer Fracture Evaluation (CAFÉ) trial show superiority of balloon kyphoplasty (BKP) over conservative management in cancer patients with VCFs with similar rate of adverse events between treatment arms. Additionally, the field is still evolving with advances such as combination with radiosurgery and spinal radiofrequency ablation (RFA), use of kyphoplasty without a balloon and highly viscous cement to prevent leakage.
Summary: VAPs are well tolerated and effective methods to provide palliative care for cancer patients with VCFs and should be offered to symptomatic patients.