Editing Vertebral augmentation (section)

== Effectiveness ==
As of 2019, the effectiveness of vertebroplasty is not supported.<ref name="Cochrane2018">{{cite journal |last1=Buchbinder |first1=R |last2=Johnston |first2=RV |last3=Rischin |first3=KJ |last4=Homik |first4=J |last5=Jones |first5=CA |last6=Golmohammadi |first6=K |last7=Kallmes |first7=DF |title=Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. |journal=The Cochrane Database of Systematic Reviews |date=6 November 2018 |volume=2018 |issue=11 |pages=CD006349 |doi=10.1002/14651858.CD006349.pub4 |pmid=30399208|pmc=6517304 }}</ref><ref name="ASBMR2019">{{cite journal|last1=Ebeling|first1=Peter R|last2=Akesson|first2=Kristina|last3=Bauer|first3=Douglas C|last4=Buchbinder|first4=Rachelle|last5=Eastell|first5=Richard|last6=Fink|first6=Howard A|last7=Giangregorio|first7=Lora|last8=Guanabens|first8=Nuria|last9=Kado|first9=Deborah|last10=Kallmes|first10=David|last11=Katzman|first11=Wendy|date=January 2019|title=The Efficacy and Safety of Vertebral Augmentation: A Second ASBMR Task Force Report|journal=Journal of Bone and Mineral Research|volume=34|issue=1|pages=3–21|doi=10.1002/jbmr.3653|pmid=30677181|doi-access=free|last14=Wilson|first14=H Alexander|last15=Bouxsein|first15=Mary L|author-link=Mary Bouxsein|first13=Robert|last12=Rodriguez|last13=Wermers|first12=Alexander}}</ref> A 2018 Cochrane review found no role for vertebroplasty for the treatment of acute or sub-acute osteoporotic vertebral fractures.<ref>{{Cite journal|last1=Buchbinder|first1=Rachelle|last2=Johnston|first2=Renea V.|last3=Rischin|first3=Kobi J.|last4=Homik|first4=Joanne|last5=Jones|first5=C. Allyson|last6=Golmohammadi|first6=Kamran|last7=Kallmes|first7=David F.|date=6 November 2018|title=Percutaneous vertebroplasty for osteoporotic vertebral compression fracture|journal=The Cochrane Database of Systematic Reviews|volume=2018|issue=11 |pages=CD006349|doi=10.1002/14651858.CD006349.pub4|issn=1469-493X|pmc=6517304|pmid=30399208}}</ref> The subjects in these trials had primarily non-acute fractures and prior to the release of the results they were considered the most ideal people to receive the procedure. After trial results were released vertebroplasty advocates pointed out that people with acute [[vertebral fracture]]s were not investigated.<ref name="Maturitas2012">{{cite journal|last=Robinson|first=Y|author2=Olerud, C|title=Vertebroplasty and kyphoplasty--a systematic review of cement augmentation techniques for osteoporotic vertebral compression fractures compared to standard medical therapy.|journal=Maturitas|date=May 2012|volume=72|issue=1|pages=42–9|pmid=22425141|doi=10.1016/j.maturitas.2012.02.010}}</ref><ref>{{cite journal|last=Gangi|first=A|author2=Clark, WA|title=Have recent vertebroplasty trials changed the indications for vertebroplasty?|journal=CardioVascular and Interventional Radiology|date=August 2010|volume=33|issue=4|pages=677–80|pmid=20523998|doi=10.1007/s00270-010-9901-3|s2cid=25901532}}</ref> A number of non-blinded trials suggested effectiveness,<ref>{{Citation | last1 =Wardlaw | first1 =Douglas | last2 =Cummings | first2 =Steven | title = Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial | journal = [[The Lancet|Lancet]] | volume =373 | pages = 1016–24 | date =2009 | issue =9668 | language =en |pmid= 19246088 | doi= 10.1016/S0140-6736(09)60010-6| s2cid =12241054 }}</ref> but the lack of blinding limits what can be concluded from the results and some have been criticized because of being funded by the manufacturer.<ref name=Maturitas2012/> One analysis has attributed the difference to [[selection bias]].<ref>{{cite journal|last=McCullough|first=BJ|author2=Comstock, BA |author3=Deyo, RA |author4=Kreuter, W |author5= Jarvik, JG |title=Major Medical Outcomes With Spinal Augmentation vs Conservative Therapy.|journal=JAMA Internal Medicine|date=Sep 9, 2013|volume=173|issue=16|pages=1514–21|pmid=23836009|doi=10.1001/jamainternmed.2013.8725 |pmc=4023124}}</ref>

Some have suggested that this procedure only be done in those with fractures less than 8 weeks old;<ref>{{cite journal|last=Clark|first=WA |author2=Diamond, TH |author3=McNeil, HP |author4=Gonski, PN |author5=Schlaphoff, GP |author6=Rouse, JC|title=Vertebroplasty for painful acute osteoporotic vertebral fractures: recent Medical Journal of Australia editorial is not relevant to the patient group that we treat with vertebroplasty.|journal=The Medical Journal of Australia|date=2010-03-15|volume=192|issue=6|pages=334–7|pmid=20230351|doi=10.5694/j.1326-5377.2010.tb03533.x |s2cid=12672714 |url=https://semanticscholar.org/paper/5ddd787a8d98ca38bb73d139b195829e28968a6a }}</ref> however, analysis of the two blinded trials appear not to support the procedure even in this acute subgroup.<ref>{{cite journal|last=Staples|first=MP|author2=Kallmes, DF |author3=Comstock, BA |author4=Jarvik, JG |author5=Osborne, RH |author6=Heagerty, PJ |author7= Buchbinder, R |title=Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials: meta-analysis.|journal=BMJ (Clinical Research Ed.)|date=Jul 12, 2011|volume=343|pages=d3952|pmid=21750078|pmc=3133975|doi=10.1136/bmj.d3952}}</ref> Others consider the procedure only appropriate for those with other health problems making rest possibly detrimental, those with metastatic [[cancer]] as the cause of the spine fracture, or those who do not improve with conservative management.<ref>{{cite journal|last=Itshayek|first=E|author2=Miller, P |author3=Barzilay, Y |author4=Hasharoni, A |author5=Kaplan, L |author6=Fraifeld, S |author7= Cohen, JE |title=Vertebral augmentation in the treatment of vertebral compression fractures: review and new insights from recent studies.|journal=Journal of Clinical Neuroscience|date=June 2012|volume=19|issue=6|pages=786–91|pmid=22595547|doi=10.1016/j.jocn.2011.12.015|s2cid=8301676}}</ref>

Evidence does not support a benefit of kyphoplasty over vertebroplasty with respect to pain, but the procedures may differ in restoring lost vertebral height, and in safety issues like cement [[extravasation]] (leakage).<ref name="Maturitas2012"/> As with vertebroplasty, several unblinded studies have suggested a benefit from balloon kyphoplasty.<ref>{{cite journal  |vauthors=Kallmes DF, Comstock BA, Heagerty PJ, etal |title=A randomized trial of vertebroplasty for osteoporotic spinal fractures |journal=N. Engl. J. Med.|volume=361 |issue=6 |pages=569–79 |date=August 2009 |pmid=19657122 |doi=10.1056/NEJMoa0900563 |pmc=2930487}}</ref><ref>{{cite journal  |vauthors=Buchbinder R, Osborne RH, Ebeling PR, etal |title=A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures |journal=N. Engl. J. Med. |volume=361 |issue=6 |pages=557–68|date=August 2009 |pmid=19657121 |doi=10.1056/NEJMoa0900429 |hdl=10536/DRO/DU:30019842 |hdl-access=free }}</ref> {{As of|2012}}, no blinded studies have been performed, and since the procedure is a derivative of vertebroplasty, the unsuccessful results of these blinded studies have cast doubt upon the benefit of kyphoplasty generally.<ref name="Zou E515-22">{{cite journal|last=Zou|first=J|author2=Mei, X |author3=Zhu, X |author4=Shi, Q |author5= Yang, H |title=The long-term incidence of subsequent vertebral body fracture after vertebral augmentation therapy: a systemic review and meta-analysis.|journal=Pain Physician|date=Jul–Aug 2012|volume=15|issue=4|pages=E515–22|pmid=22828697}}</ref>

Some vertebroplasty practitioners and some health care professional organizations continue to advocate for the procedure.<ref>Moan R. [http://www.searchmedica.com/resource.html?rurl=http%3A%2F%2Fwww.diagnosticimaging.com%2Fdisplay%2Farticle%2F113619%2F1533095&q=vertebroplasty&c=ra&ss=diagnosticImagingLink&p=Convera&fr=true&ds=0&srid=1Debate continues over value of vertebroplasty]. Diagnostic Imaging. 2010;32(2) 5.</ref><ref>{{cite journal|last=Jensen|first=ME |author2=McGraw, JK |author3=Cardella, JF |author4=Hirsch, JA|title=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.|journal=Journal of Vascular and Interventional Radiology|date=July 2009|volume=20|issue=7 Suppl|pages=S326–31|pmid=19560019|doi=10.1016/j.jvir.2009.04.022}}</ref><ref name="clarketal">{{cite journal |last1=Clark |first1=William |last2=Bird |first2=Paul |last3=Diamond |first3=Terrance |last4=Gonski |first4=Peter |last5=Gebski |first5=Val |title=Cochrane vertebroplasty review misrepresented evidence for vertebroplasty with early intervention in severely affected patients |journal=BMJ Evidence-Based Medicine |date=9 March 2019 |volume=25 |issue=online first |pages=bmjebm–2019–111171 |doi=10.1136/bmjebm-2019-111171 |pmid=30852489 |pmc=7286037 |doi-access=free }}</ref>  In 2010, the board of directors of the [[American Academy of Orthopaedic Surgeons]] released a statement recommending strongly against use of vertebroplasty for osteoporotic spinal compression fractures,<ref>{{citation | title=The Treatment of Symptomatic Osteoporotic Spinal Compression Fractures: Guideline and Evidence Report| author=Esses, Stephen I.| publisher=American Academy of Orthopaedic Surgeons| url=http://www.aaos.org/Research/guidelines/SCFguideline.pdf|date=September 2010|display-authors=etal}}</ref> while the Australian Medical Services Advisory Committee considers both vertebroplasty and kyphoplasty only to be appropriate in those who have failed to improve after a trial of conservative treatment,<ref name=MSAC2011/> with conservative treatment (analgesics primarily) being effective in two-thirds of people.<ref name=Mon2012>{{cite journal|last=Montagu|first=A|author2=Speirs, A |author3=Baldock, J |author4=Corbett, J |author5= Gosney, M |title=A review of vertebroplasty for osteoporotic and malignant vertebral compression fractures.|journal=Age and Ageing|date=July 2012|volume=41|issue=4|pages=450–5|pmid=22417981|doi=10.1093/ageing/afs024|doi-access=free}}</ref> The [[National Institute for Health and Care Excellence]] similarly states that the procedure in those with osteoporotic fractures is only recommended as an option if there is severe ongoing pain from a recent fracture even with optimal pain management.<ref>{{cite web|title=Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures|url=https://www.nice.org.uk/guidance/ta279/resources/guidance-percutaneous-vertebroplasty-and-percutaneous-balloon-kyphoplasty-for-treating-osteoporotic-vertebral-compression-fractures-pdf|website=NICE The National Institute for Health and Care Excellence|access-date=17 March 2015|page=3|date=April 2013|archive-url=https://web.archive.org/web/20150402152256/https://www.nice.org.uk/guidance/ta279/resources/guidance-percutaneous-vertebroplasty-and-percutaneous-balloon-kyphoplasty-for-treating-osteoporotic-vertebral-compression-fractures-pdf|archive-date=2 April 2015|url-status=dead}}</ref>

[[Vertebral body stenting]], also known by the brand Kiva, is a similar procedure which also has poor evidence to support its use.<ref name=ASBMR2019/>