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

The authors present a retrospective study about the treatment of vertebral body compression fractures (VBCF) in patients with osteoporosis using a closed reduction maneuver and a mini open transpedicular approach for the placement of bone graft and a body augmenter. The presented data appear sound and are well documented. The presented treatment method remains a principle concern. My first concern is regarding the reduction maneuver: this method has been advocated by trauma surgeons for the initial treatment in traumatic fractures. The application of this technique to the population with osteoporosis appears critical—manipulating patients in the described manner with severe osteoporosis might expose them to rib fractures or fractures of the sacrum or femoral neck and should therefore be avoided in this group of patients. It has been shown in a well-documented study by Voggenreiter [3] that the spontaneous kyphosis correction by positioning the patients is already substantial. If a reduction is needed other techniques should be considered. My second concern addresses the principle of the technique: transpedicular bone grafting was advocated by Daniaux for traumatic fractures in combination with internal fixation. However, the reported results of other authors failed to support this principle. Looking at the surgical technique presented here, again the same concerns do appear. I am in doubt that the presented technique will provide the same