However, Chen et al [21] showed improved pain relief in chronic fractures >3 months treated with VA compared to conservative management at 1 year follow-up. Implant kyphoplasty is being performed more after the Sakos Trial findings supported the use of titanium implantable VA devices as an early treatment option for painful, acute VCFs with excellent risk/benefit profile [126]. Tutton et al [20] in the KAST study (The Kiva safety and effectiveness Trial), a multicentered randomized control trial successfully established that the Kiva system is noninferior to BK based on a composite primary endpoint assessment incorporating pain-, function-, and device-related serious adverse events for the treatment of osteoporotic VCFs. Cianfoni et al [127] demonstrated the use of stent-assisted internal fixation as a minimally invasive option to obtain VA and restore axial load capability in severe osteoporotic fractures, potentially obviating more invasive surgical interventions in situations that would pose significant challenges to standard VA. When the etiology of the VCF is questionable, biopsy may be necessary and can be performed as a part of the VA procedure [128,129]. Percutaneous Ablation Spine Percutaneous thermal ablation procedures are reserved for symptomatic spinal metastatic disease [112]. Surgical Consultation Surgical intervention is reserved for patients with neurologic deficits, spinal deformity (eg, junctional kyphosis, retropulsion), or spinal instability. Several surgical techniques have been developed to treat osteoporosis-related deformities, including posterior instrumentation with fusion. However, achieving fixation and fusion in these patients can be difficult secondary to insufficient bone integrity. Augmentation methods to improve pedicle screw fixation have evolved, including instrumentation at multiple levels, bioactive cement augmentation, and fenestrated or expandable pedicle screws, but their impact on clinical outcomes remains unknown.
Management of Vertebral Compression Fractures PCAs. However, Chen et al [21] showed improved pain relief in chronic fractures >3 months treated with VA compared to conservative management at 1 year follow-up. Implant kyphoplasty is being performed more after the Sakos Trial findings supported the use of titanium implantable VA devices as an early treatment option for painful, acute VCFs with excellent risk/benefit profile [126]. Tutton et al [20] in the KAST study (The Kiva safety and effectiveness Trial), a multicentered randomized control trial successfully established that the Kiva system is noninferior to BK based on a composite primary endpoint assessment incorporating pain-, function-, and device-related serious adverse events for the treatment of osteoporotic VCFs. Cianfoni et al [127] demonstrated the use of stent-assisted internal fixation as a minimally invasive option to obtain VA and restore axial load capability in severe osteoporotic fractures, potentially obviating more invasive surgical interventions in situations that would pose significant challenges to standard VA. When the etiology of the VCF is questionable, biopsy may be necessary and can be performed as a part of the VA procedure [128,129]. Percutaneous Ablation Spine Percutaneous thermal ablation procedures are reserved for symptomatic spinal metastatic disease [112]. Surgical Consultation Surgical intervention is reserved for patients with neurologic deficits, spinal deformity (eg, junctional kyphosis, retropulsion), or spinal instability. Several surgical techniques have been developed to treat osteoporosis-related deformities, including posterior instrumentation with fusion. However, achieving fixation and fusion in these patients can be difficult secondary to insufficient bone integrity. Augmentation methods to improve pedicle screw fixation have evolved, including instrumentation at multiple levels, bioactive cement augmentation, and fenestrated or expandable pedicle screws, but their impact on clinical outcomes remains unknown.