Curr Rev Musculoskelet Med (2008) 1:84–87 However, experimental studies of calcium phosphate grafts have raised concerns of limited ability to convert into bone [14]. Further evidence in material science and animal studies support claims that the compaction of a wet granular material such as morselized bone results in a phase change to a more stable solid form [13, 15]. The characteristics of this phase change can be likened to the change of proper- ties of dry sand to the properties of wet, packed sand, such as is observed in a sandcastle. This is largely due to increased crowding of particles [15]. There has been little discussion in the literature about the cost effectiveness of surgical management of VCFs, and much of the existing discussion is contradictory. More has been published about the cost effectiveness of verteb- roplasty than about other techniques. Although surgery often leads to pain relief where medication has failed, many authors have reached no conclusion about the cost beneﬁt of any procedure. Danish researchers have indicated that the cost of vertebroplasty is offset by the reduction in future hospital visits [16]. Although there is considerable excitement surrounding Optimesh, the data in case reports are not enough to fully assess the outcomes. The elimination of PMMA cement will likely reduce the incidence of several known compli- cations. It is not possible however, to predict if other problems will be generated through the use of Optimesh. Pulmonary thromboemboli and fat emboli have been recorded in vertebroplasty and kyphoplasty, and there is concern that the reaming process and the compacting steps used in Optimesh application may promote the dislodging of bone marrow, which could hypothetically amplify this problem [2]. Additionally, the high degree of ﬂuctuation in the frequency of adjacent compression fractures in both vertebroplasty and kyphoplasty show that the variables leading to this complication, despite many arguments related to vertebral stiffness, have not been completely assessed. Conclusions Optimesh is a new technology. Although a few successful cases have been reported, these do not constitute a statis- tically signiﬁcant sample set to make any deﬁnitive statements about the safety and general outcomes follow- ing PMCMA application. However, given both the initial 87 successes seen in some patients and the potential for further beneﬁt, additional investigation into both short-term and long-term patient outcomes is warranted. References 1. Chiu J, Stechison MT. Percutaneous vertebral augmentation and reconstruction with an intravertebral mesh and morcelized bone graft. Surg Technol Int 2005;14:287–96. 2. Lam S, Khoo LT. 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