Introduction  Osteoporosis with subsequent osteoporotic vertebral compression fractures is an increasingly important disease due to the increasing age of our population and the significant economic impact.  Pain reduction and sometimes, stabilization are of primary importance. Conservative treatment consisting of rest or
activity modification, analgesic and bracing usually works to a greater or lesser extent. Patients might look for quicker and better alternatives, and such fractures are increasingly treated with minimally invasive bone angmentation techniques such as vertebroplasty and kyphoplasty. Both methods are reported to be effective on
pain relief. However, the possible complications and subsequent additional fractures should not be overlooked. Indications Before identifying the indications for surgical intervention, the different types of vertebral
osteoporotic fractures should be defined according to international standards.
The Anatomical and pathological situations should be considered. The vascular (venous) system of the vertebral column should be understood thoroughly. The basic biomechanics of the spinal column with its individual units should also be respected. With these careful considerations, a tight indication will be agreed on. Methodology Perfect surgical technique and imaging facilities should be available and the techniques, relevant to the equipments and implant (kyphoplasty) used should be thoroughly mastered. Comparing Vertebroplasty and kyphoplasty Apart from the difference in costs, vertebroplasty and kyphoplasty should be compared from many different angles. The relative pain reduction following either procedure could be compared. The structural restoration, radiographic changes, risk factors, complications and survival, could all be compared. There are two important RCT studies on vertebroplasty planned and reported in 2007. The first INVEST study and the second VERTOS II study are underway.  We await for the results. Conclusions Thus far, there is no uniformly agreed indications for minimally invasive vertebral augmentation. Neither is there proved advantage of kyphoplasty relative to vertebroplasty with regard to pain relief, vertebral height restoration, and complication rate. It is possible that both vertebroplasty and kyphoplasty are useful in the treatment of vertebral compression fractures and that certain subgroups of patients may derive more benefit from one particular procedure. Features that might affect choice of procedure include degree of compression deformity, age of the fracture, and the presence of neoplastic involvement. However, benefits of kyphoplasty relative to vertebroplasty in such subgroups currently remain undefined. With the considerable added financial expense of kyphoplasty, a significant clinical benefit over vertebroplasty would have to be proved to justify this expense.