Heini, Paul

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The authors present a retrospective study about thetreatment of vertebral body compression fractures(VBCF) in patients with osteoporosis using a closedreduction maneuver and a mini open transpedicularapproach for the placement of bone graft and a bodyaugmenter. The presented data appear sound and arewell documented.The presented treatment method remains a princi-ple concern. My first concern is regarding the reductionmaneuver: this method has been advocated by traumasurgeons for the initial treatment in traumatic frac-tures. The application of this technique to the popu-lation with osteoporosis appears critical—manipulatingpatients in the described manner with severe osteo-porosis might expose them to rib fractures or fracturesof the sacrum or femoral neck and should therefore beavoided in this group of patients. It has been shown in awell-documented study by Voggenreiter [3] that thespontaneous kyphosis correction by positioning thepatients is already substantial. If a reduction is neededother techniques should be considered.My second concern addresses the principle of thetechnique: transpedicular bone grafting was advo-cated by Daniaux for traumatic fractures in combi-nation with internal fixation. However, the reportedresults of other authors failed to support this princi-ple. Looking at the surgical technique presented here,again the same concerns do appear. I am in doubtthat the presented technique will provide the sameresults in the hands of less experienced surgeons. Onthe contrary I would warn that the technique couldlead to further complications as fractures of thepedicles with secondary instability. Yes, osteoporoticvertebra are soft and pedicles may be plastically en-larged, but the mechanical stability of osteoporoticvertebrae depends strongly on the integrity of theirstructure.The last concern regards the comparison of thistechnique with percutaneous cement augmentation(vertebroplasty, kyphoplasty). The authors are listingall shortcomings of the technique of cement rein-forcement, which are important to realize. However,they ignore many newer studies that show the impor-tance of cement viscosity [1] and the potential of thetechnique for this increasing problem of osteoporoticspine [2]. Many arguments against percutaneouscementing techniques like the lack of long-term resultsare not valid and apply as well to this presentedalternative technique. The huge success of cementreinforcement for VBCF is self-explaining. The pre-sented technique in the article above is not an alter-native to overcome the problems related with vertebralbody augmentation by cement. A more standardizedtechnique with adapted cements and seriously trainedsurgeons is the solution.This comment refers to the article available at http://dx.doi.org/10.1007/s00586-006-0197-6.P. F. Heini (&)Department of Orthopaedic Surgery,Inselspital, 3010 Bern, Switzerlande-mail: paul.heini@insel.chEur Spine J (2007) 16:599–600DOI 10.1007/s00586-006-0217-6123REVIEWER’S COMMENTComment on ‘‘Transpedicle body augmenter in painfulosteoporotic compression fractures’’ (Kung-Chia Li,Anna F.-Y. Li, Ching-Hsiang Hsieh, Hsiang-Ho Chen)Paul F. HeiniAccepted: 20 August 2006 / Published online: 9 September 2006 Springer-Verlag 2006References1. Bohner M, Gasser B, Baroud G et al (2003) Theoretical andexperimental model to describe the injection of a polymeth-ylmethacrylate cement into a porous structure. Biomaterials24:2721–27302. Heini PF (2005) The current treatment—a survey of osteopo-rotic fracture treatment. Osteoporotic spine fractures: the spinesurgeon’s perspective. Osteoporos Int 16(Suppl 2):S85–S923. Voggenreiter G (2005) Balloon kyphoplasty is effective indeformity correction of osteoporotic vertebral compressionfractures. Spine 30:2806–2812600 Eur Spine J (2007) 16:599–600123

Comment on "Transpedicle body augmenter in painful osteoporotic compression fractures” (Kung-Chia Li, Anna F.-Y. Li, Ching-Hsiang Hsieh, Hsiang-Ho Chen)

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Comment on "Transpedicle body augmenter in painful osteoporotic compression fractures” (Kung-Chia Li, Anna F.-Y. Li, Ching-Hsiang Hsieh, Hsiang-Ho Chen)

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