title: Controversial issues in kyphoplasty and vertebroplasty in malignant vertebral fractures.
abstract: BACKGROUND
  Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed in the treatment of pathological vertebral fractures.
  
  
  METHODS
  A critical review of the medical literature was performed and controversial issues were analyzed.
  
  
  RESULTS
  Evidence supports KP as the treatment of choice to control fracture pain and the possible restoration of sagittal balance, provided that no overt instability or myelopathy is present, the fracture is painful and other pain generators have been excluded, and positive radiological findings are present. Unilateral procedures yield similar results to bilateral ones and should be pursued whenever feasible. Biopsy should be routinely performed and 3 to 4 levels may be augmented in a single operation. Higher cement filling appears to yield better results. Radiotherapy is complementary with KP and VP but must be individualized.
  
  
  CONCLUSIONS
  In cases of painful cancer fractures, if overt instability or myelopathy is not present, unilateral KP should be pursued, whenever feasible, followed by radiotherapy. The technological advances in hardware and biomaterials, as well as combining KP with other modalities, will help ensure a safe and more effective procedure. Address.
authors.affiliation: Neuro-Oncology Program, Moffitt Cancer Center, Tampa, FL 33612, USA. ioannis.papanastassiou@gmail.com.
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Papanastassiou
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Filis
authors.forename: Maria A
authors.initials: MA
authors.lastname: Gerochristou
authors.forename: Frank D
authors.initials: FD
authors.lastname: Vrionis
mesh_terms: D006801:Humans; D058498:Kyphoplasty / Q000379:methods*; D016103:Spinal Fractures / Q000473:pathology* / Q000628:therapy*; D013125:Spinal Neoplasms / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*