Abstract No. 728 Vertebral augmentation: comparing frequency and specialities that perform vertebroplasties and kyphoplasties

Abstract

Vertebral compression fractures are a common pathology in the elderly. The standard of care was to treat with vertebral augmentation procedures such as vertebroplasties (VP) and kyphoplasties (KP). However, in 2009, The New England Journal of Medicine (NEJM) published two reports showing no beneficial effect of vertebral augmentation compared to a placebo. Although this study was debunked due to design flaws and additional research has shown vertebral augmentation to be effective, research indicates a steady decline in vertebral augmentation. This study examines how frequently vertebral augmentation is performed and which specialties are performing it. A retrospective analysis was done using data from the Physicians Compare National Database File from the Center for Medicare Services (CMS) database between 2012-2017. Data was selected based on the current procedural terminology (CPT) code. Once the data was collected, the procedures were separated based on which specialist performed the procedure. Specialties were grouped into interventional radiology (IR), spine surgery (SS) or pain management (PM). The data showed that IR performed 1107 (83.9%) of VPs, SS performed 139 (10.5%) and PM performed 73 (5.5%). The data also showed that IR performed 2478 (35.4%) of KPs, SS performed 3613 (51.7%) and PM performed 887 (12.7%). The data showed a 15% decrease in vertebral augmentation procedures. While this may be attributed to the NEJM study, the data indicate there may be more nuance to the decline. First, while both procedures decreased, VPs decreased by 45% while KPs only decreased by 9%. One explanation for this difference is that since VPs and KPs have similar outcomes, but KPs are better reimbursed, physicians may prefer KPs. This is supported by the data, which showed KPs are performed 5x more frequently compared to VPs. Second, although KPs decreased overall, when analyzed by specialty, IR and PM remained approximately the same while SS decreased by 20%. Since SSs account for about 50% of total KPs, this indicates a potential opportunity for IR to perform more KPs and increase their market share.