Curr Rev Musculoskelet Med (2008) 1:84–87 rigidity and stability to the site after the cement has cured, thereby preventing further compression of the affected vertebral body [3, 7]. Kyphoplasty is a more recent percutaneous technique that utilizes a pressurized, inﬂatable balloon tamp to create a void within the vertebral body. This space is then ﬁlled with PMMA [1, 2, 8]. Both techniques appear to be effective, with a high percentage of patients (greater than 90%) reporting pain relief. Good functional outcomes are generally observed as well, although kyphoplasty has been more successful in the restoration of vertebral height and kyphotic angle [3–12]. Despite these beneﬁts, both procedures are not without complications. The Optimesh system was developed by Spineology, Inc. (St. Paul, MN) and recently received FDA-approval as a means for percutaneous vertebral augmentation (PVA). It provides an alternative technique to stabilize and treat VCFs that are refractory to conservative management options. Methods and results Three databases were searched (OVID, PubMed, and Google Scholar), using varying combinations of the following keywords or terms: vertebroplasty, kyphoplasty, spine fracture, percutaneous, compression fracture, allo- graft, and Optimesh. These searches resulted in 764, 271, 594, 253, 7, and 2 items. These items were manually sor- ted. Only two items directly related to polyethylene mesh- contained morcelized allograft (PMCMA) were found. These two items were technique descriptions and lacked clinical outcome data. The authors of both articles recog- nized that the next step needed to better assess the role of optimesh in the management of osteoporotic VCFs would be a study of clinical outcomes. Discussion The Optimesh system utilizes a unique design. It uses a mesh bag that is made from a woven biocompatible poly- ester (Dacron). One important mesh characteristic is that it is porous enough to allow ﬂuid transmission and possibly vascular ingrowth. The pore size, however, is small enough to prevent leakage of the granular bone graft material. It is also capable of expanding upon injection to accommodate for any irregularities in the size and shape of the cavity generated during surgery [2, 13]. Technique description The patient is placed prone and prepped in the usual sterile fashion on a radiolucent table. Digital C-arm ﬂuoroscopy is 85 necessary for proper anatomical localization of the affected VCF and for instrumentation of the vertebral body. Next, the guide pin is advanced into the vertebral body via a lateral extrapedicular approach. A dilator is placed over the guide pin and advanced into the vertebral body. Care should be made to ensure that the guide pin is not inadvertently advanced as the dilator is delivered into the VCF site. Next, the access portal is placed over dilator. The dila- tor-guide pin assembly is then removed. A drill is used to initiate cavity creation. This initial space is subsequently enlarged with shaper-reamers. These expandable reamers are used to create a cavity, which will ultimately contain the morcelized graft ﬁlled mesh [1, 2, 13]. The reamers are available in two sizes (5.8 or 10 mm diameter), and are capable of producing a cavity of various diameters (14, 22, and 25 mm diameter) [2]. This is followed by insertion of the woven Optimesh implant sac. The tools and techniques required to implant the graft material have been uniquely developed. A bone ﬁll-tube, which inserts into the mesh bag provides a channel for delivery of graft material. A bone push-rod ﬁts into the ﬁll tube to both deliver and gradually compact the graft material [1, 2]. In this manner, the sac is densely ﬁlled with morcelized bone graft. With the bone graft location conﬁrmed with ﬂuoroscopy, the instruments are removed. The wounds are irrigated and subsequently closed. Comparison to vertebroplasty and kyphoplasty Compression of the paste-like bone graft preparation dur- ing delivery causes exudation of the liquid component into the surrounding porous bone. This leaves only the morc- elized graft behind in the mesh-containment bag. During this maneuver, the physical properties of the graft prepa- ration change from that of a semisolid paste to a solid that more closely mimic bone [2, 13]. Furthermore, this is achieved without the risk of high-pressure injection that is needed to insert PMMA. Another advantage over PMMA is that the porous graft containment system has the potential to be both osteoconductive and osteoinductive [1, 2 13]. Optimesh is intended to provide a minimally invasive surgical option to treat various forms of intraosseous ver- tebral insufﬁciency, most commonly osteoporotic fractures. Although clinical studies remain to be done, there appear to be several perceived advantages to Optimesh over verteb- roplasty/kyphoplasty in regards to complication avoidance. Known risks associated with the use of vertebroplasty and kyphoplasty include PMMA emboli, neurological com- pression from intracanal cement leak, and foreign body reaction [1, 2, 4–6, 9, 10].