title: Percutaneous vertebral augmentation in fragility fractures-indications and limitations.
abstract: BACKGROUND
  There is still no general consensus about the management of osteoporotic vertebral fractures. Recommendations depend on type of fracture, grade of instability, bone quality, and general conditions of the patient. Spontaneous fractures may be considered to be treated different compared to cases with high-velocity trauma.
  
  
  METHODS
  According to the DVO, patients without trauma should first be treated conservatively. However, there is no more strict time protocol of 3 or 6 week conservative treatment before operations may be indicated. Surgical criteria are not yet distinctly defined. For highly unstable fractures (type B and C according to the AO Spine Classification), posterior instrumentation with cement augmented screws and as long construct, respectively, is adequate. Current literature has been analysed for diagnostic and therapeutic protocols.
  
  
  RESULTS
  There is no clear operative concept for burst fractures and classic osteoporotic fractures with dynamic ongoing sintering. Percutaneous vertebral augmentation showed to prevent the fractures from ongoing kyphotic deformity and the patients from painful immobilization. Indications and results of classical vertebroplasty and kyphoplasty have been discussed intensively in the literature. Further development included special injection techniques, cements with different viscosities and stenting systems to reach more stable constructs and avoid typical complications, such as cement extrusion.
  
  
  CONCLUSIONS
  This review reports upon indications and limitations of percutaneous vertebral augmentation and the potential development of classifications and therapeutic algorithms.
authors.affiliation: Department of Spine Surgery, BGU Trauma Center, Prof. Küntscher Str. 8, 82418, Murnau, Germany. oliver.gonschorek@bgu-murnau.de.
authors.forename: O
authors.initials: O
authors.lastname: Gonschorek
authors.affiliation: Department of Spine Surgery, BGU Trauma Center, Prof. Küntscher Str. 8, 82418, Murnau, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Hauck
authors.affiliation: Department of Spine Surgery, BGU Trauma Center, Prof. Küntscher Str. 8, 82418, Murnau, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Weiß
authors.affiliation: Department of Spine Surgery, BGU Trauma Center, Prof. Küntscher Str. 8, 82418, Murnau, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Bühren
mesh_terms: D001843:Bone Cements; D001863:Bone Screws; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D058866:Osteoporotic Fractures / Q000601:surgery*; D016103:Spinal Fractures / Q000601:surgery*; D054854:Vertebroplasty / Q000379:methods*
chemical_list: D001843:Bone Cements
keywords: Cement augmentation; Kyphoplasty; Osteoporotic fracture; Percutaneous technique; Thoracolumbar spine; Vertebroplasty