Description
The speaker discusses management of vertebral compression fractures, emphasizing prevention of progression from mild to severe fracture and kyphosis. He explains indications for vertebroplasty, cement augmentation, and kyphoplasty, noting that no technique is clearly superior. He describes the procedure, including Jamshidi needle placement and how fresh fractures may self-reduce in the prone position, allowing better cement fill. Major complications are reviewed: cement leakage, local neural compression, pulmonary or cardiac embolism, and fat embolism, especially with multi-level augmentation. To reduce risk, he recommends waiting for cement to become more viscous, using larger needles and smaller syringes, and injecting cement stepwise rather than all at once. He also presents vertebral body lavage, a technique developed to wash out fat before cement injection, which reportedly reduces leakage, fat embolism, and hemodynamic instability. For selected trauma patients, he describes motion-preserving approaches such as stentoplasty and a combined technique using cement in one region and fixation in another, with good clinical and radiographic outcomes in small series. The talk ends with a case discussion about whether to operate on a 70-year-old woman with a T12 fracture and pain, concluding that if she is improving and neurologically intact, observation may be reasonable, but the decision should be individualized based on pain, kyphosis, sagittal balance, and fracture progression.