ORIGINAL RESEARCH Analysis of vertebral augmentation practice patterns: a 2016 update Joshua A Hirsch, 1 Ronil V Chandra, 2 Vidsysagar Pampati, 3 John D Barr, 4 Allan L Brook, 5 Laxmaiah Manchikanti 6 1 Neuroendovascular Program and NeuroInterventional Spine Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA 2 Interventional Neuroradiology Service, Departments of Medicine and Surgery, Monash Imaging, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia 3 Pain Management Center of Paducah, University of Louisville, Paducah, Kentucky, USA 4 Departments of Radiology and Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA 5 Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA 6 Pain Management Center of Paducah, University of Louisville, Louisville, Kentucky, USA Correspondence to Dr J A Hirsch, Neuroendovascular Program and NeuroInterventional Spine Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Hirsch@snisonline.org Accepted 20 September 2016 To cite: Hirsch JA, Chandra RV, Pampati V, et al. J NeuroIntervent Surg 2016;8:1299–1304. ABSTRACT Objective To evaluate procedure utilization patterns for vertebroplasty and kyphoplasty in the US Medicare population from 2004 to 2014. Methods The analysis was performed using the Centers for Medicare and Medicaid Services database of specialty utilization files for the fee for service (FFS) Medicare population. Results The FFS Medicare population increased by 28% with an annual increase of 2.5% from 2004 to 2014. Utilization of vertebroplasty procedures decreased by 63% with an average annual decrease of 9.5% from 2004 to 2014 per 100 000 FFS Medicare beneficiaries. During the same time period, kyphoplasty procedures decreased by a total of 10%, with an average annual decrease of 1.3%. For augmentation generally (combined vertebroplasty/kyphoplasty data) there was thus an overall decrease in the rate per 100 000 Medicare population of 32% from 2004 to 2014, with an average annual decrease of 4.8%. The majority of vertebroplasty procedures were performed by radiologists whereas the majority of kyphoplasties were performed by orthopedic surgeons and neurosurgeons. Conclusions There has been a significant decline in vertebroplasty and kyphoplasty procedures in the FFS Medicare population between 2004 and 2014. INTRODUCTION Vertebral compression fractures are the most common type of osteoporotic fracture and are also associated with malignancy. Osteoporotic vertebral fractures affect 117 per 100 000 persons, with the primary symptom of back pain that can be debili- tating. 12 These fractures are associated with a pro- longed impact on health related quality of life, 2 and the direct management costs are estimated at more than $1 billion per annum. 3 Similarly, patients with malignancy commonly develop bone metastases. Vertebral fractures in cancer patients may be due to metastases, osteonecrosis after radi- ation therapy, and/or osteopenia caused by systemic anticancer treatments. In these cohorts of patients, minimally invasive percutaneous treatments, such as vertebroplasty and kyphoplasty, have become common in the USA. Initial enthusiasm was driven by multiple observa- tional studies and comprehensive reviews showing positive results. 4–7 In fact, vertebroplasty increased from a rate of 43 per 100 000 Medicare population in 2001 to 85 in 2008. 8 Along the same lines, kyphoplasty increased from 120 per 100 000 Medicare population to 141 in 2008. However, two randomized controlled trials of vertebroplasty for osteoporotic spinal fractures were published in the New England Journal of Medicine (NEJM) in 2009. 9 10 These trials showed lack of effectiveness of vertebroplasty compared with sham surgery, and impacted on the utilization rates of both vertebro- plasty and kyphoplasty. While utilization patterns of other interventional techniques continued to demonstrate substantial increases, 11–13 vertebro- plasty decreased from 85 per 100 000 Medicare population to 49 in 2010, and kyphoplasty decreased from 141 per 100 000 Medicare popula- tion to 121 in the year 2010. 8 Since publication of these two trials in 2009, multiple additional randomized controlled trials confirmed prior observations that have demon- strated benefit for vertebroplasty and kyphoplasty for both osteoporotic and cancer related vertebral fractures compared with conservative care. 14–20 Recently, vertebroplasty has also been demonstrated to be effective compared with sham surgery for patients with acute fractures. 21 Thus our aim was to evaluate the procedure utilization patterns for vertebroplasty and kyphoplasty in the Medicare population from 2004 to 2014. MATERIALS AND METHODS This analysis of data of utilization patterns of verteb- roplasty and kyphoplasty procedures was performed following the reporting standards of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidance. 22 Institutional review board approval was not required for this assessment as public use files available through the Centers for Medicare and Medicaid Services (CMS) database was utilized. 23 This analysis exclusively used non-attributable de-identified data. Study design The purpose of the study was to retrospectively evaluate the utilization patterns of thoracolumbar vertebroplasty and kyphoplasty procedures from 2004 to 2014 by fee for service (FFS) Medicare beneficiaries. These physician/supplier procedure summary master files were aggregates of all Medicare part B billing claims for services per- formed in the USA by all providers. These data were purchased from the CMS. Setting The CMS database of specialty utilization from 2004 to 2014 data files of FFS Medicare was uti- lized. 23 This is a 100% sample. Hirsch JA, et al. J NeuroIntervent Surg 2016;8:1299–1304. doi:10.1136/neurintsurg-2016-012767 1 of 7 Spine on June 12, 2020 by guest. Protected by copyright. http://jnis.bmj.com/ J NeuroIntervent Surg: first published as 10.1136/neurintsurg-2016-012767 on 31 October 2016. Downloaded from