Mechanical augmentation for vertebral compression fractures: A scoping review

Vertebral compression fractures (VCFs) contribute substantially to pain, disability, and healthcare burden. Vertebroplasty and balloon kyphoplasty (KP) are widely used but limited by cement leakage and inconsistent vertebral height restoration. Mechanical vertebral augmentation (MVA) techniques were developed to improve vertebral alignment and cement containment, yet their comparative outcomes remain incompletely defined. To map and synthesize the existing evidence on MVA compared with KP or vertebroplasty across seven clinically relevant domains, including cement extravasation, alignment correction, pain and disability outcomes, morbidity and mortality, and feasibility in complex fracture patterns. A comprehensive search of MEDLINE, Embase, and Web of Science identified studies evaluating MVA in adult VCFs. Data were charted according to seven predefined research questions and synthesized descriptively using scoping-review methodology. Forest plots were used to visualize the ranges and distributions of reported outcomes across studies. Fifty-two studies met inclusion criteria. Across studies, MVA demonstrated a trend toward lower cement extravasation rates compared with KP, although definitions and detection methods varied and intradiscal leakage was generally reported as asymptomatic. Vertebral height restoration and alignment correction were often greater or more consistently achieved with MVA devices, but the clinical relevance of these differences remains uncertain. However, improved structural correction did not consistently translate into superior clinical outcomes across studies. Adjacent fracture rates ranged widely, with some studies describing lower rates after MVA and others showing similar or higher rates, particularly in cases involving more aggressive correction. Evidence describing morbidity or mortality differences across augmentation techniques was limited, and long-term comparative data remain sparse. Overall, available findings support the feasibility and short-term safety of MVA, though heterogeneity in reporting limits firm conclusions. Current evidence suggests that MVA is a feasible and safe treatment option for VCFs, including complex morphologies. Although some studies report differences in radiographic correction or cement leakage patterns between MVA and KP, the clinical significance remains uncertain, and improved structural correction does not consistently translate into superior clinical outcomes. High-quality randomized trials with standardized imaging and clinical outcome reporting are needed to clarify how different augmentation strategies compare and whether structural restoration achieved with MVA leads to consistent, meaningful improvements in patient outcomes.