Novel Bone Materials and Adjunctive Approaches in Percutaneous Vertebral Augmentation for Neoplastic Vertebral Compression Fractures

Neoplastic vertebral compression fractures are a debilitating complication of cancer, causing pain, limiting function, and reducing quality of life. Image-guided percutaneous vertebral augmentation (PVA) involves the injection of bone cement with or without a device into the vertebra. This offers effective stabilization and pain relief but has limitations. The standard polymethylmethacrylate cement is stiffer than native bone and lacks the ability to promote bone regeneration, raising concerns about poor biointegration and increased risk of future fractures. Moreover, exothermic polymerization can only destroy tumor cells within a limited area. Novel materials, such as polysiloxane, ceramics, and composites, offer improved bone integration and release of antineoplastic drugs. Additionally, various strategies that can be combined with PVA, such as radiation therapy, ablation techniques, interventional tumor removal, and minimally invasive screw fixation, could not only address the underlying neoplasm but also provide additional vertebral stabilization and reduce complications. While these advances hold promise, further research is needed to establish their safety and efficacy compared with the standard approach. Future endeavors should prioritize improving the mechanical properties of alternative materials to standard bone cement and facilitating large, long-term randomized controlled trials to validate the clinical outcomes of combined approaches and optimize treatment selection.