Indications and Contraindications
Treatment Goals: Alleviation of pain and vertebral body
stabilization
Indications
Painful Fractures
- Osteoporotic fracture refractory to medical therapy
- Benign or malignant tumor: hemangioma, multiple myeloma, metastatic
lesion
- Osteonecrosis
Unstable
Fractures
- Unstable fractures with movement at wedge deformity
- Multiple thoracic compression deformities with decreased thoracic
cage threatens pulmonary compromise, impacts appetite, GI function, balance
- Possible structural reinforcement prior to surgical
stabilization
Patient Selection
- Focused pain in region of fracture
- Fracture tender to palpation
- Absence of radicular pain
- Subacute or acute fractures less than one year old yield greatest
results (less than 4-6 months ideal); older fractures can also be treated
- Fracture unresponsive to medical therapy (analgesics, bedrest,
immobilization)
- Fracture with activity on bone scan or edema on MRI, if in
combination with other selection criteria
- Pain from fracture negatively impacting mobility and ADLs
Contraindications
Absolute
Contraindications
- Asymptomatic stable fracture
- Clinically effective medical therapy
- Osteomyelitis of target vertebra
- Uncorrected coagulation disorders
- Acute traumatic fracture of non-osteoporotic vertebra
- Prophylaxis with no evidence of acute fracture
- Allergy to any required component
- Local or systemic infection
Relative
Contraindications
- Radicular pain or radiculopathy caused by a compressive syndrome
unrelated to vertebral body collapse
- Retropulsed fragment with > 20% spinal canal compromise
- Tumor extension into epidural space
- Severe vertebral body collapse (vertebra plana)
- Stable fracture without pain older than one year
Review additional information about
compression fracture
treatment.
