[Vertebroplasty and kyphoplasty in patients with osteoporotic fractures: secured knowledge and open questions].

Cementoplasty, performed either as percutaneous vertebroplasty or kyphoplasty, has become well established as an effective technique to treat painful vertebral body fractures. It has low complication rates, is successful in alleviating pain, and improves the patients' mobility and quality of life. A series of questions remain open though or are the subject of controversial debate; for example, the results of several biomechanical studies are in part contradictory. Clinical data on subsequent fractures are also still inadequate, although the majority of studies show no elevated rate of subsequent fractures following treatment with cementoplasty in comparison to the natural course in patients with osteoporotic fractures. Kyphoplasty has the advantage of being able to restore the vertebral body height or reduce the kyphosis angle without leading to different clinical outcomes in comparison to vertebroplasty. Biomechanical considerations on whether restoration of the vertebral body's normal shape could reduce the rate of subsequent fractures still need scientific substantiation. Both surgical methods are employed in our clinic. Kyphoplasty seems to us to be indicated when the height of the anterior portion of the vertebral body is reduced by one-third compared to the norm or a kyphosis angle of more than 15-20 degrees is present. The goals of therapy are restoring the shape and reducing the kyphosis angle. This can only succeed, however, in fractures that are not older than 3 weeks. In all other cases vertebroplasty is performed.