Percutaneous Vertebral Augmentation: The Status of Vertebroplasty and Current Controversies Rikin Hargunani, B.Sc., M.B.B.S., M.R.C.S., F.R.C.R., 1,2 Thomas Le Corroller, M.D., M.Sc., 1,2 Khalid Khashoggi, M.B.B.S., F.R.C.P.C., 1,2 Kieran J. Murphy, M.B., F.R.C.P.C., F.S.I.R., 3 and Peter L. Munk, M.D., C.M., F.R.C.P.C. 1,2 ABSTRACT Vertebroplasty is a cost-effective procedure for the relief of pain and suffering in the appropriate patient when done by a skilled practitioner under good image guidance. No study has ever shown any cost benefit of any balloon-based osteoporotic spine intervention over simple vertebroplasty. No study has ever shown any benefit of any intravertebral implant over vertebroplasty for osteoporotic compression fracture. Recent controversy has highlighted weaknesses in our practice of technology evaluation, and we need to address these issues across the board in the future more scientifically then we have done in the past. KEYWORDS: Vertebroplasty, osteoporotic fracture, pathological fracture, image guidance, simplicity Vertebral compression fractures secondary to osteoporosis become a common affliction as patients age. It has become a particularly high-profile issue in the Western world over the last 30 years as perceptible aging of the population and increased life expectancy have meant that a larger population of patients are presenting with this clinical problem. 1,2 Many fractures are asymptomatic and produce mild self-resolving pain, but symptomatic vertebral compression fractures can be extremely challenging to treat. The mainstay of treat- ment has been conservative therapy with bed rest, which in the vast majority of patients results in a satisfactory outcome. A minority of patients, probably < 25%, find they have ongoing pain that may be debilitating, sig- nificantly compromises quality of life or ability to work, and require chronic analgesic use with its inherent complications. 3,4 The expense involved in treating these patients, as well as the loss in productivity, is significant. In a study published in 1997, it was estimated that in the United States alone as many as 700,000 compression fractures occur annually, which may have been an under- estimate. 2 With the aging of the population this number has continued to increase. In the mid-1980s in France, the first vertebro- plasty was performed. Initially this technique, which involved the percutaneous injection of cement into a symptomatic cervical hemangioma under imaging guid- ance, was used principally in patients with hemangiomas of bone and metastatic disease. 5,6 The results were so dramatic and gratifying that cement injections were soon 1 Department of Radiology, Vancouver General Hospital, Vancou- ver, British Columbia, Canada; 2 University of British Columbia, Vancouver, British Columbia, Canada; 3 Department of Medical Imaging, University Health Network, University of Toronto, Tor- onto, Ontario, Canada. Address for correspondence and reprint requests: Peter L. Munk, M.D., Department of Radiology, Vancouver General Hospital, 855 West 12th Ave., Vancouver, BC V5Z 1M9 Canada (e-mail: peter.munk@vch.ca). Spine Imaging and Intervention; Guest Editors, Peter L. Munk, M.D., C.M., F.R.C.P.C. and Kieran J. Murphy, M.B., F.R.C.P.C., F.S.I.R. Semin Musculoskelet Radiol 2011;15:117–124. Copyright # 2011 Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: + 1(212) 584-4662. DOI: http://dx.doi.org/10.1055/s-0031-1275594. ISSN 1089-7860. 117 Downloaded by: IP-Proxy University College of London, University College of London. Copyrighted material.