Mortality, Outcomes, and Healthcare Utilization with Spinal Augmentation

Vertebroplasty and kyphoplasty, known collectively as spinal augmentation, have received widespread acceptance as effective, minimally invasive treatments for rapid symptomatic relief following osteoporotic vertebral compression fractures. Spinal augmentation involves percutaneous injection of bone cement into the collapsed vertebral body.

Previous studies and trials have shown the benefits of spinal augmentation for the treatment of vertebral compression fractures. Two large randomized-controlled trials (RTCs) that compared vertebroplasty and kyphoplasty with conservation, nonsurgical therapies found significant reductions in pain, analgesic usage, and disability with the procedure at 1 month and 1 year. However, results from 2 double-blinded RTCs did not demonstrate improvements in pain or disability with vertebroplasty and “suggest that the benefits of spinal augmentation might largely reflect a placebo effect."

Several recent studies have suggested that spinal augmentation is associated with reductions in mortality; however, a small retrospective cohort did not support those findings.

Researchers recently conducted a study to compare mortality, rates of major medical complications, and several other measures of healthcare utilization in patients with osteoporotic vertebral fractures who were treated with either spinal augmentation or conservative therapy [JAMA Intern Med. 2013;173(6):1514-1521].

The main outcomes and measures of the retrospective cohort analysis were mortality, major complications, and healthcare utilization. The researchers utilized Medicare claims for the 2002 to 2006 time period to compare 30-day and 1-year outcomes in patients with newly diagnosed vertebral fractures treated with spinal augmentation (n=10,541) or conservative therapy (control group, n=115,851).

At 30 days following the index vertebral fracture, mortality was lower in the augmented group compared with the control group (0.4% vs 1.5%; odds ratio [OR], 0.29; 95% confidence interval [CI], 0.20-0.41). At 1 year, mortality remained significantly lower in the augmented group compared with controls, but the relative difference was attenuated (5.2% vs 6.7%; hazard ratio [HR], 0.83; 95% CI, 0.75-0.92).

There were significantly fewer major medical complications in the augmented group compared with the control group during the 30 days following the index fracture (9.3% vs 10.4%; OR, 0.85; 95% CI, 0.79-0.92). Rates of complications were equal at 1 year (28.9% for both; HR, 1.00; 95% CI, 0.95-1.04).

The study found that in the year following the index vertebral fracture, compared with the control group, the augmented group had significantly higher rates of hospitalizations (excluding those for the spinal augmentation), admission to intensive care units (ICUs), and discharges to skilled nursing facilities (SNFs). In the augmented group, the first of these events occurred after the procedure in a majority of patients: 70.7% (n=4472) of the hospitalizations, 86.9% (n=1278) of the ICU admissions, and 76.4% (n=1746) of the SNF discharges.