Vertebral Compression Fractures: Optimal Augmentation Material Selection

Learning Objectives:
1. To review current augmentation material options for treatment of vertebral compression fractures including injectable polymethyl methacrylate (PMMA), composite cement, biodegradable cement, calcium phosphate cement (CPC), and newer cementless biologic materials. 2. To present the optimal role of each agent based on the clinical and anatomic scenario. 3. To highlight the varying biomechanical and biochemical effects each augmentation material has on the spine. 4. To recognize the unique benefits, risks, and complications associated with each augmentation material.



Background: Vertebral compression fractures remain a leading cause of morbidity and mortality affecting nearly 1.5 million individuals in the U.S. annually {1}. Augmentation remains an effective intervention for vertebral compression fractures that are refractory to nonoperative management and results in pain improvement, decreased opioid requirements, and enhancement of quality of life {2,3}. Multiple augmentation materials are available for interventional therapy including unique cement formulations and biologics. Each material has distinctive characteristics, and operator optimal selection of agent can improve technical and clinical outcomes in spinal augmentation procedures.

Clinical Findings/Procedure Details:
This exhibit will describe the biomechanical and biochemical effects of injectable PMMA, composite cement, biodegradable cement, CPC, and biologic material on the spine. Pictorial models will be used to demonstrate the relevant anatomic and procedural details that accompany augmentation with each material. Evidence-based review of the literature will be provided to assess the clinical and technical outcomes of each agent. Lastly, there will be a discussion on future improvements in care through the exploration of available augmentation agents and materials under development.


Conclusion and/or Teaching Points:
After reviewing this exhibit, the viewer will gain a deeper understanding of spinal augmentation materials, proper agent selection for optimal clinical and technical outcomes, and current and future developments in spinal augmentation techniques and agents.