Position statement on percutaneous vertebral augmentation: a consensus statement developed by the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, American Association of Neurological Surgeons/Congress of Neurological Surgeons, and American Society of Spine Radiology.

It is the position of the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, American Association of Neurologic Surgeons/Congress of Neurologic Surgeons, and American Society of Spine Radiology (“the Societies”) that percutaneous vertebral augmentation with vertebroplasty and kyphoplasty is a safe, efficacious, and durable procedure in appropriate patients with symptomatic osteoporotic and neoplastic fractures when performed in a manner in accordance with published standards. These procedures are offered only when traditional medical therapy has not provided pain relief or pain is substantially altering the patient’s lifestyle. With regard to vertebroplasty, multiple case series and retrospective and prospective nonrandomized studies have shown a statistically significant improvement in pain and function—particularly with regard to ambulation—and these results have been confirmed in a prospective study with use of a control group and in a prospective randomized control study. The benefits of vertebroplasty far outweigh its risks and the risks of conservative therapy, and the success rate is consistently high. This procedure is cost-effective because it produces immediate improvement in a patient’s quality of life, primarily by means of the alleviation of pain and rapid return to ambulation. In addition to reducing the need for costly skilled care, expensive drugs, or orthopedic devices, a return to ambulation is known to reduce adverse outcomes in elderly patients confined to bed. Kyphoplasty has been introduced as an alternative approach. It is similar to vertebroplasty and has been referred to as “balloon-assisted vertebroplasty.” Kyphoplasty entails the inflation of a percutaneously delivered balloon in the vertebral body followed by the percutaneous injection of bone cement into the cavity created by the balloon. The balloon is intended to restore the vertebral body height in addition to creating the cavity. After reviewing the published literature on kyphoplasty, the Societies have determined that the clinical response rate in individuals treated with kyphoplasty is equivalent to that seen in patients treated with vertebroplasty. There is no proved advantage of kyphoplasty relative to vertebroplasty with regard to pain relief, vertebral height restoration, or complication rate. It is the position of the Societies that vertebral augmentation with vertebroplasty or kyphoplasty is a medically appropriate therapy for the treatment of painful vertebral compression fractures refractory to medical therapy when performed for the medical indications outlined in the published standards. We believe vertebral augmentation with vertebroplasty or kyphoplasty is established therapy and should be reimbursed by payors as a safe and effective treatment for painful compression fractures.