Minimally invasive vertebral augmentation for osteoporotic vertebral compression fractures

Table 1 Comparison of percutaneous vertebroplasty and percutaneous kyphoplasty

Parameter	Percutaneous vertebroplasty	Percutaneous kyphoplasty
Main principle	Direct cement injection	Balloon-assisted cavity creation followed by cement filling
Operative burden	Lower	Higher
Height restoration	Limited	Better
Kyphosis correction	Limited	Better
Leakage control	Depends heavily on injection control	Potential advantage as injection usually involves lower pressure
Typical clinical use	Rapid stabilization in frail patients or those with less deformity	Acute/subacute fracture with greater collapse or deformity
Cost	Lower	Higher

Table 2 Common complications and preventive strategies in vertebral augmentation

Complication	Main mechanism or concern	Key preventive strategy
Cement leakage	High pressure injection, cortical disruption, posterior wall defect	Incremental injection, real-time imaging, appropriate cement viscosity, accurate needle placement
Adjacent vertebral fracture	Baseline osteoporosis with possible additional biomechanical stress	Anti-osteoporosis treatment, fall prevention, balanced correction, longitudinal follow-up
Pulmonary cement embolism	Venous migration of cement	Avoid overly early low-viscosity injection, monitor cement spread continuously
Infection	Contamination or poor perioperative control	Strict sterile technique and perioperative risk optimization
Neurological injury	Malposition or symptomatic leakage	Accurate puncture trajectory and immediate imaging assessment when symptoms occur

Table 3 Summary of minimally invasive treatments for osteoporotic vertebral compression fractures

Technique	Principle	Advantages	Limitations	Typical indications
Percutaneous vertebroplasty	Direct polymethylmethacrylate cement injection	Rapid pain relief, shorter operative time, lower cost	Limited height restoration, leakage concern	Acute/subacute painful fracture when stabilization is prioritized and procedural burden should be minimized
Percutaneous kyphoplasty	Balloon cavity creation followed by cement filling	Better height restoration, better kyphosis correction, lower-pressure injection	Higher cost, more procedural steps	Acute/subacute fracture with substantial collapse, deformity, or need for partial height restoration
Stent-assisted kyphoplasty	Expandable stent maintains cavity	Potential structural support and resistance to recollapse	Limited evidence, higher cost	Selected severe collapse cases
Navigation- or robot-assisted augmentation	Technology-guided puncture and cement delivery	Higher accuracy, less radiation, potentially better cement distribution	Equipment cost and limited availability	Complex anatomy, difficult puncture, or revision setting