The role of intracorporeal cancellous bone grafting in the biological augmentation of vertebral body fractures: a literature review, historical perspective, and update on imaging and bone healing outcomes.

Background and Objective: Interior vertebral body augmentation enables minimally invasive reconstruction from within by filling the void created by trabecular collapse, restoring endplate alignment, and supporting the anterior and middle columns. Although traditional intracorporeal cancellous bone grafting has been associated with unfavorable outcomes due to insufficient early stability, its use in combination with modern stabilization techniques may represent an effective strategy for biological vertebral body repair. This study aims to provide an updated review of the scientific literature on the role of intracorporeal cancellous bone grafting in the augmentation of vertebral body fractures. Methods: A literature review of the PubMed/MEDLINE database was performed focusing on imaging outcomes and bone healing findings in clinical studies evaluating intracorporeal cancellous bone grafting for vertebral body fractures. Key Content and Findings: Fifty-five studies were included, addressing acute traumatic or osteoporotic thoracolumbar fractures and post-traumatic vertebral necrosis (Kümmell's disease). The literature was categorized into three sections: grafting alone (2 studies), grafting combined with fixation of adjacent vertebrae (35 studies, ranging from early techniques to modern pedicle screw constructs), and grafting combined with intravertebral stabilization (intermediate pedicle screws, 5 studies; static cages, 9; expandable implants, 4). Imaging and bone healing outcomes were heterogeneous, yet most studies reported favorable imaging, bone union, and clinical results, underscoring the benefits of combining supplemental stabilization methods with intracorporeal bone grafting in biological vertebral augmentation. Less favorable outcomes were observed in only 9 studies (16.36%), primarily involving stand-alone grafting or grafting combined with adjacent pedicle fixation, and were characterized by vertebral height loss, segmental angle reduction, necrosis, and graft resorption. Conclusions: Based on heterogeneous, low-level evidence, this narrative review suggests that less favorable outcomes with intracorporeal bone grafting were mainly due to insufficient vertebral stability, suboptimal grafting, and disc injury with consequent segmental kyphosis. Outcomes appear influenced by the type of additional stabilization used alongside grafting. In selected studies using modern stabilization-such as pedicle screws or intravertebral augmentation-acceptable short- to mid-term bone healing and imaging outcomes were reported. However, effect size and consistency vary, and further prospective, comparative, subgroup-specific studies are needed to confirm effectiveness.