Revisiting Cement Augmentation in Osteoporotic Vertebral Fractures: A Narrative Review; [골다공증성 척추 골절에서 골시멘트 보강술의 재조명: 서술적 문헌고찰]

Abstract

Study Design: This narrative review synthesizes recent literature on cement augmentation techniques for osteoporotic vertebral fractures, together with current anti-osteoporotic pharmacologic therapies. Objectives: To evaluate recent advancements in bone cement augmentation, with a focus on material innovations, procedural refinements, and adjunctive therapies that improve vertebral stability and clinical outcomes. Summary of Literature Review: Polymethylmethacrylate (PMMA) remains the standard augmentation material because of its high compressive strength and predictable polymerization characteristics. However, its stiffness mismatch with osteoporotic bone may increase stress at adjacent vertebral levels. Advances in cement viscosity optimization and low-pressure injection techniques have reduced cement leakage while maintaining mechanical stability. Comparative studies indicate that both percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) provide effective pain relief, with PKP demonstrating superior vertebral height restoration and kyphotic angle correction. Implant-assisted systems, such as SpineJack, further enhance vertebral body expansion and sagittal alignment while reducing cement volume and leakage. Despite these technical improvements, secondary vertebral fractures remain frequent, underscoring the importance of adjunctive pharmacologic therapies, including anabolic agents such as teriparatide and romosozumab, to promote bone regeneration. Materials and Methods: A comprehensive literature review of English-language studies involving human subjects was conducted, including clinical trials, experimental studies, reviews, and meta-analyses. Results: Both PVP and PKP were associated with significant short-term pain relief, with PKP showing greater vertebral height restoration and kyphotic correction. Implant-assisted augmentation systems, including SpineJack, demonstrated improved vertebral alignment and lower rates of cement leakage. Nonetheless, the incidence of adjacent vertebral fractures remained substantial, highlighting the need for concomitant osteoporosis treatment. Conclusions: Cement augmentation remains essential in OVCF management. An integrated approach that combines biomechanical optimization with systemic anabolic osteoporosis therapy may offer the greatest potential for achieving both structural stability and biological bone restoration. © 2025 Korean Society of Spine Surgery.