Vertebral augmentation: update on safety, efficacy, cost effectiveness and increased survival?

Area of Science:

• Orthopedics
• Interventional Pain Medicine
• Evidence-Based Medicine

Background:

• Over 300 articles annually discuss vertebral augmentation, yet its efficacy and safety for vertebral fractures remain debated.
• An evidence base is crucial for current clinical practice, healthcare policy, and funding decisions regarding vertebral augmentation.

Purpose of the Study:

• To summarize the highest quality evidence on the efficacy, safety, cost-effectiveness, and potential survival benefits of vertebroplasty and kyphoplasty.
• To examine recent prospective randomized trials and meta-analyses evaluating vertebral augmentation outcomes.
• To review procedural safety data, including complications and subsequent fractures, and analyze national database findings on hospital stay and mortality.

Main Methods:

• Narrative review of prospective multicenter randomized sham-controlled and conservative management-controlled trials.
• Examination of recent meta-analyses and systematic reviews on vertebral augmentation efficacy.
• Review of safety data on medical complications, cement leaks, and subsequent fractures.
• Analysis of national database publications on length of hospital stay and mortality.
• Consideration of emerging literature on cost-effectiveness.

Main Results:

• Summarizes design, inclusion criteria, outcomes, and limitations of key trials.
• Examines recent meta-analyses and systematic reviews on efficacy.
• Reviews procedural safety data and national database findings.
• Considers cost-effectiveness literature.

Conclusions:

• Provides interventional pain physicians with a summary of the latest, high-quality data on vertebral augmentation.
• Facilitates evidence-based clinical decision-making by integrating data with clinical expertise and patient preferences.
• Highlights the need for a robust evidentiary basis to support the continued use of vertebral augmentation.