ISASS Policy Statement – Vertebral Augmentation
- Public Policy
- ISASS Policy Statement – Vertebral Augmentation
- Liz Vogt
- March 18, 2013
ISASS Policy Statement – Vertebral Augmentation
It is estimated that over 1.4 million people will develop vertebral compression fractures every year (Johnell & Kanis 2006). Many will be clinically insignificant or heal with non-operative treatment. A large group will have persistent pain, kypholic deformity, weight loss, depression and a reduced quality of life. (Old & Calvert 2004; Borgstrom et al. 2006; Suzuki et al. 2008).
Open surgical intervention is used when there is severe deformity, instability, or neurologic compromise. Vertebral augmentation such as Vertebroplasty (VP) and balloon kyphoplasty (BKP) are minimally invasive techniques used to treat painful vertebral compression fractures. There is good evidence that these techniques can provide immediate and lasting pain relief (Berlemann et al. 2004; Grafe et al. 2005; Groh et al. 2005; Alvarez et al. 2006; DeNegri et al. 2007; Lovi et al. 2009; Schofer et al. 2009; Wardlaw et al. 2009; Klazen et al. 2010; Liu et al. 2010; Santiago et al. 2010; Boonen et al. 2011). At the same time there is evidence that not all patients with vertebral compression fractures benefit from these procedures (Buchbinder et al. 2009; Kalmes et al. 2009; Rousing et al. 2009; Wardlaw et al. 2009; Klazan et al. 2010). Technology assessment efforts and meta-analyses have arrived at different conclusions regarding the value of vertebral augmentation, but are based on different studies depending on the timing of analyses and publications (Taylor et al. 2006a,b; Hulme et al. 2006; Eck et al. 2007; AAOS 2010; Papanastassiou et al. 2011).
Based on current evidence and in the interest of our patients ISASS offers the following guidelines:
- The presence of a vertebral compression fracture is not by itself an indication for vertebral augmentation.
- Patients with back pain and vertebral compression fractures should be carefully evaluated to determine if other reasons for pain exist.
- Patients with painful vertebral fractures, where other causes of pain have been evaluated, are candidates for vertebral augmentation when they fail non-operative treatment. This is particularly the case when the pain is increasing or disabling or there is progressive collapse of the fracture.
- The patient should be evaluated with an MRI to determine that it has not healed and that there are no additional fractures which were missed on the x-ray. A bone scan is also helpful in this respect.
- Vertebral augmentation procedures are not the same. Studies of VP cannot be used to evaluate studies of BKP and vice versa.
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