Collection Editors: Mary E. Jensen and Joshua A. Hirsch
About 6 months ago, I asked Drs. Jensen and Hirsch to put together this Special Collection on vertebral augmentation. AJNR has published many of the seminal articles on this topic and continues to do so. Thus, there is a tremendous wealth of material that we all thought could be compiled into one source. Little did all of us know that destiny would “throw us a curve ball” on August 6, when the New England Journal of Medicine published the now famous (or infamous?) articles that attempted to debunk vertebroplasty as treatment for painful osteoporotic spinal fractures. Although these articles by Buchbinder et al and Kallmes et al were prospective and randomized ones, their design is not without flaws and they have elicited a considerable amount of controversy. An editorial by Weinstein accompanied the articles and dealt with the economic impact of the procedure. Not surprisingly, the media immediately caught onto the controversies and the articles were featured on front page of the New York Times the next day.
These events make this compilation of articles even more (and not less, as some may think) pertinent. I truly believe that in carefully selected patients, vertebroplasty offers the means for fast pain relief. Let me tell you a story that is happening right now at my hospital. The widow of one of the fathers of neuroradiology was admitted to the geriatric service with a history of debilitating back pain (she can no longer go the bathroom by herself) of a few weeks' duration. Last night, an MRI showed 4 thoracolumbar compression osteoporotic fractures still bright on STIR images. We discussed vertebroplasty with her physician who, based on those 2 articles, dismissed the idea of sending her to radiology for treatment. We are aware that vertebroplasty may not control her pain, but at the end of her life it seems the least aggressive means of getting her some relief within an adequate timeframe. I think that we neuroradiologists have been rigorous in documenting our experience with vertebral augmentation in the literature. The best sample of such documentation is found in this collection.
I can imagine the dismay felt by Lee and Josh when, so close to finishing this effort, those 2 articles appeared. They kept working however to deliver what was promised. In this Special Collection they include 38 articles nicely categorized. They wisely concluded with the multisociety position statement on vertebroplasty. Now is the time for the reader to decide if the procedure is beneficial or not and to act accordingly. Many thanks to Lee and Josh for a fantastic job!
M. Castillo
Editor-in-Chief
To see an article, click its [Full Text] link. To review many abstracts, check the boxes to the left of the titles you want, and click the 'Get All Checked Abstract(s)' button. To see one abstract at a time, click its [Abstract].
Introduction:
M.E. Jensen and J.A. Hirsch Percutaneous Vertebroplasty
AJNR Am J Neuroradiol 2009;30:s2 [Full Text] [PDF]
Technique:
A Gangi, BA Kastler, and JL Dietemann Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy
AJNR Am J Neuroradiol 1994;15:83-86 [Abstract] [PDF]
The first paper to introduce the concept of “percutanous vertebroplasty,” it described the technical aspects of the procedure using a combination of CT and fluoroscopy in the treatment of 10 patients with various causes of vertebral collapse.
ME Jensen, AJ Evans, JM Mathis, DF Kallmes, HJ Cloft, and JE Dion
Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects
AJNR Am J Neuroradiol 1997;18:1897-904 [Abstract] [PDF]
As the second most highly cited paper in AJNR’s history, this foundational study described the fluoroscopically guided vertebroplasty technique, pitfalls and tricks, complications, and clinical response, thus promoting awareness among neuroradiologists and launching the procedure.
John M. Mathis, A. Orlando Ortiz, and Gregg H. Zoarski
Vertebroplasty versus Kyphoplasty: A Comparison and Contrast
AJNR Am J Neuroradiol 2004;25:840-45 [Full Text] [Figures Only] [PDF]
A comparison of the 2 dominant forms of vertebral augmentation, this paper demonstrated similar safety and efficacy rates, equivalent height restoration and kyphosis reduction between the 2 techniques, and a substantial cost difference that favored vertebroplasty.
Francisco Mont’Alverne, Jean-Noel Vallée, Evelyne Cormier, Remy Guillevin, Hector Barragan, Betty Jean, Michelle Rose, and Jacques Chiras
Percutaneous Vertebroplasty for Metastatic Involvement of the Axis
AJNR Am J Neuroradiol 2005;26:1641-45 [Abstract] [Full Text] [Figures Only] [PDF]
The first paper to describe the feasibility, safety, and efficacy of the anterolateral approach to metastatic lesions of the C2 vertebral body, the authors described the procedure, and its risks, benefits, and complications in this technically challenging approach.
Safety/Complications:
Harry J. Cloft, David N. Easton, Mary E. Jensen, David F. Kallmes, and Jacques E. Dion
Exposure of Medical Personnel to Methylmethacrylate Vapor during Percutaneous Vertebroplasty
AJNR Am J Neuroradiol 1999;20:352-53 [Abstract] [Full Text] [PDF]
The first paper to address the potential risks of PMMA exposure to medical personnel involved in vertebroplasty, this investigation determined that ambient MMA vapor concentrations during performance of the procedure were well below the OSHA-recommended maximum workday exposure.
Timothy J. Kaufmann, Mary E. Jensen, Gabriele Ford, Lena L. Gill, William F. Marx, and David F. Kallmes
Cardiovascular Effects of Polymethylmethacrylate Use in Percutaneous Vertebroplasty
AJNR Am J Neuroradiol 2002;23:601-04 [Abstract] [Full Text] [PDF]
This paper sought to address the well-known association between PMMA use and cardiovascular abnormalities during hip arthroplasty as it pertains to vertebroplasty, and, in a retrospective review, the authors found no generalized association between PMMA injection during vertebroplasty and systemic cardiovascular derangement.
Cristiana Vasconcelos, Philippe Gailloud, Norman J. Beauchamp, Donald V. Heck, and Kieran J. Murphy
Is Percutaneous Vertebroplasty without Pretreatment Venography Safe? Evaluation of 205 Consecutive Procedures
AJNR Am J Neuroradiol 2002;23:913-17 [Abstract] [Full Text] [Figures Only] [PDF]
This large consecutive series of vertebroplasties demonstrated that PMMA injection without antecedent vertebral venographic documentation of the potential venous outlets was safe and efficacious, and eliminated the risk of contrast reaction or pooling, which could obscure visualization during the procedure.
David F. Kallmes, Erwin O, Soma Sinha Roy, Richard G. Piccolo, William F. Marx, Jae K. Lee, and Mary E. Jensen
Radiation Dose to the Operator during Vertebroplasty: Prospective Comparison of the Use of 1-cc Syringes versus an Injection Device
AJNR Am J Neuroradiol 2003;24:1257-60 [Abstract] [Full Text] [Figures Only] [PDF]
In this safety paper investigating the radiation exposure to the operator’s hand during vertebroplasty, the authors determined that use of an injection device versus 1-cc syringes significantly decreased the radiation dose per unit time of injection, but the total dose per injection was equivalent between the 2 methods because of significantly longer injection durations associated with the injection device cohort.
A.T. Trout and D.F. Kallmes Does Vertebroplasty Cause Incident Vertebral Fractures? A Review of Available Data
AJNR Am J Neuroradiol 2006;27:1397-403 [Abstract] [Full Text] [PDF]
This exhaustive review article summarized the biomechanical and clinical data supporting and refuting a causal relationship between vertebroplasty and the development of incident vertebral compression fractures, without demonstrating conclusive evidence one way or the other.
A.O. Ortiz, V. Natarajan, D.R. Gregorius, and S. Pollack Significantly Reduced Radiation Exposure to Operators during Kyphoplasty and Vertebroplasty Procedures: Methods and Techniques
AJNR Am J Neuroradiol 2006;27:989-94 [Abstract] [Full Text] [Figures Only] [PDF]
Given the rapid increase in the number of vertebral augmentations performed annually, this timely paper compared the radiation exposure to the operator in the settings of kyphoplasty, vertebroplasty using a cement delivery system, and vertebroplasty performed with syringes. Moreover, it detailed many radiation-saving techniques operators can use to protect themselves.
A.T. Trout, D.F. Kallmes, J.I. Lane, K.F. Layton, and W.F. Marx
Subsequent Vertebral Fractures after Vertebroplasty: Association with Intraosseous Clefts
AJNR Am J Neuroradiol 2006;27:1586-91 [Abstract] [Full Text] [Figures Only] [PDF]
This paper alerted practitioners to the increased subsequent fracture risk in patients with treated intraosseous clefts. The authors’ observation was that this group is at greater risk for additional fracture, at a rate 2 times greater than treated patients without pre-existing clefts.
Biomechanics:
Michael Mu Huo Teng, Chao-Jung Wei, Liang-Chen Wei, Chao-Bao Luo, Jiing-Feng Lirng, Feng-Chi Chang, Chien-Lin Liu, and Cheng-Yen Chang Kyphosis Correction and Height Restoration Effects of Percutaneous Vertebroplasty
AJNR Am J Neuroradiol 2003;24:1893-900
[Abstract] [Full Text] [Figures Only] [PDF]
Following vertebroplasty in the hyperextended position, this paper described improvement in vertebral body height, wedge angle, and, to a lesser degree, kyphosis angle, particularly in vertebrae with intraosseous clefts, with these findings approximating those reported in the kyphoplasty literature.
Matthew J. Provenzano, Kieran P. J. Murphy, and Lee H. Riley, III
Bone Cements: Review of Their Physiochemical and Biochemical Properties in Percutaneous Vertebroplasty
AJNR Am J Neuroradiol 2004;25:1286-90 [Abstract] [Full Text] [PDF]
This paper was the first to review the physiochemical and biomechanical properties of various bone cements used in vertebroplasty, with emphasis on strength and stiffness testing, polymerization properties, their effects on bone adherence and formation, and the consequences of additives.
Sean Molloy, Lee H. Riley, III, and Stephen M. Belkoff Effect of Cement Volume and Placement on Mechanical-Property Restoration Resulting from Vertebroplasty
AJNR Am J Neuroradiol 2005;26:401-04 [Abstract] [Full Text] [Figures Only] [PDF]
This paper addressed the issues of laterally vs centrally placed PMMA and low vs high volume fills as they relate to strength and stiffness, and the concern that asymmetric collapse would occur with hemivertebral injections, which was proved to be unfounded in this in vitro model.
John I. Lane, Timothy P. Maus, John T. Wald, Kent R. Thielen, Shalabh Bobra, and Patrick H. Luetmer
Intravertebral Clefts Opacified during Vertebroplasty: Pathogenesis, Technical Implications, and Prognostic Significance
AJNR Am J Neuroradiol 2002;23:1642-46
[Abstract] [Full Text] [Figures Only] [PDF]
This retrospective review identified intraosseous clefts, which were often not demonstrated on preoperative imaging, in close to one-third of all treated vertebrae. There was a trend toward better outcomes 6 to 12 months after treatment when compared with individuals whose treated levels did not demonstrate clefts.
A. Hiwatashi, P.-L.A. Westesson, T. Yoshiura, T. Noguchi, O. Togao, K. Yamashita, H. Kamano, and H. Honda
Kyphoplasty and Vertebroplasty Produce the Same Degree of Height Restoration
AJNR Am J Neuroradiol 2009;30:669-73 originally published online on January 8 2009, 10.3174/ajnr.A1442 [Abstract] [Full Text] [Figures Only] [PDF]
This comparative study of morphologic changes associated with vertebroplasty and kyphoplasty confirmed previous findings that both techniques achieve the same degree of height restoration and wedge angle improvement, with no difference in symptomatic PMMA leakage in either cohort.
Adjunctive Imaging:
A. Stanley Maynard, Mary E. Jensen, Patricia A. Schweickert, William F. Marx, John G. Short, and David F. Kallmes
Value of Bone Scan Imaging in Predicting Pain Relief from Percutaneous Vertebroplasty in Osteoporotic Vertebral Fractures
AJNR Am J Neuroradiol 2000;21:1807-12 [Abstract] [Full Text] [Figures Only] [PDF]
This retrospective paper was the first to use bone scan as a preoperative tool in patient selection, demonstrating that increased activity identified by bone scintigraphy is highly predictive of a positive clinical response to percutaneous vertebroplasty.
M.H.J. Voormolen, W.J. van Rooij, Y. van der Graaf, P.N.M. Lohle, L.E.H. Lampmann, J.R. Juttmann, and M. Sluzewski
Bone Marrow Edema in Osteoporotic Vertebral Compression Fractures after Percutaneous Vertebroplasty and Relation with Clinical Outcome
AJNR Am J Neuroradiol 2006;27:983-88 [Abstract] [Full Text] [Figures Only] [PDF]
This prospective study followed the MR imaging appearance of successfully treated vertebral levels at 3-, 6-, and 12-month intervals. It showed a gradual decrease in bone marrow edema over 1 year with no temporal relationship to the patient’s pain relief, which occurred most dramatically in the first 3 months.
M.H.J. Voormolen, W.J. van Rooij, M. Sluzewski, Y. van der Graaf, L.E.H. Lampmann, P.N.M. Lohle, and J.R. Juttmann Pain Response in the First Trimester after Percutaneous Vertebroplasty in Patients with Osteoporotic Vertebral Compression Fractures with or without Bone Marrow Edema
AJNR Am J Neuroradiol 2006;27:1579-85 [Abstract] [Full Text] [Figures Only] [PDF]
This unique paper showed a statistically significant difference in clinical response favoring patients with bone marrow edema (BME) on pretreatment MR imaging over patients without BME. However, despite the difference, 71% of the latter group had a favorable response, allowing the authors to conclude that vertebroplasty should not be withheld based on absence of BME alone.
Clinical Trials:
Jeffrey G. Jarvik and Richard A. Deyo
Cementing the Evidence: Time for a Randomized Trial of Vertebroplasty
AJNR Am J Neuroradiol 2000;21:1373-74 [Full Text] [PDF]
This prescient commentary argued that vertebroplasty should be evaluated in a randomized prospective manner against a control group, citing the problems inherent in studying low back pain treatments such as “regression to the mean,” and placebo effect, and the idea that equipoise had not been reached.
Clinical Outcomes (Osteoporosis):
E.M. Knavel, A. Ehteshami Rad, K.R. Thielen, and D.F. Kallmes
Clinical Outcomes with Hemivertebral Filling during Percutaneous Vertebroplasty
AJNR Am J Neuroradiol 2009;30:496-99 originally published online on January 15 2009, 10.3174/ajnr.A1416 [Abstract] [Full Text] [Figures Only] [PDF]
Although the issue of hemivertebral PMMA filling was addressed from a biomechanical viewpoint in 2005, this clinical paper confirmed that “hemivertebroplasty” achieves similar good outcomes with respect to pain, mobility, and disability when compared to a cohort of patients with holovertebral filling, in addition to no greater risk of asymmetrical refracture or adjacent fracture.
L.A. Gray, A. Ehteshami Rad, J.R. Gaughen, Jr., T.J. Kaufmann, and D.F. Kallmes
Efficacy of Percutaneous Vertebroplasty for Multiple Synchronous and Metachronous Vertebral Compression Fractures
AJNR Am J Neuroradiol 2009;30:318-22 originally published online on October 14 2008, 10.3174/ajnr.A1328 [Abstract] [Full Text] [Figures Only] [PDF]
This retrospective review of 655 patients divided into 3 cohorts (treatment of a single fracture, multiple synchronous fractures, or multiple metachronous fractures) showed that significant pain relief and improved mobility are achieved regardless of the number of fractures treated in a single procedure, or the total number of treatment sessions.
D.F. Kallmes, B.A. Comstock, L.A. Gray, P.J. Heagerty, W. Hollingworth, J.A. Turner, L. Stout, and J.G. Jarvik Baseline Pain and Disability in the Investigational Vertebroplasty Efficacy and Safety Trial
AJNR Am J Neuroradiol 2009;30:1203-05 originally published online on February 26 2009, 10.3174/ajnr.A1519 [Abstract] [Full Text] [PDF]
The first look at the cohort in this prospective, randomized, blinded control study of vertebroplasty to date (INVEST), this study compared the baseline characteristics of the study cohort to a group of patients who declined enrollment and found the groups to be similar in demographics and back pain-specific disability.
V.T. Lehman, L.A. Gray, and D.F. Kallmes
Percutaneous Vertebroplasty for Painful Compression Fractures in a Small Cohort of Patients with a Decreased Expectation-Related Placebo Effect due to Dementia
AJNR Am J Neuroradiol 2008;29:1461-64 originally published online on June 12 2008, 10.3174/ajnr.A1173 [Abstract] [Full Text] [PDF]
The first study to address the role of the “placebo effect” in vertebroplasty outcomes, this paper demonstrated a high rate of pain relief and improved mobility in patients with dementia—a population known to have a decreased expectation-related placebo response— suggesting that the improved outcomes in vertebroplasty are indeed a true effect.
K.F. Layton, K.R. Thielen, C.A. Koch, P.H. Luetmer, J.I. Lane, J.T. Wald, and D.F. Kallmes
Vertebroplasty, First 1000 Levels of a Single Center: Evaluation of the Outcomes and Complications AJNR Am J Neuroradiol 2007;28:683-89 [Abstract] [Full Text] [Figures Only] [PDF]
This largest and longest of the prospective series of treated vertebroplasty patients showed statistically significant immediate and sustained (up to 2 years) good outcomes as measured by the VAS and the Roland-Morris Disability score, with a low complication rate comprising primarily rib fractures.
M.H.J. Voormolen, W.P.T.M. Mali, P.N.M. Lohle, H. Fransen, L.E.H. Lampmann, Y. van der Graaf, J.R. Juttmann, X. Jansssens, and H.J.J. Verhaar
Percutaneous Vertebroplasty Compared with Optimal Pain Medication Treatment: Short-Term Clinical Outcome of Patients with Subacute or Chronic Painful Osteoporotic Vertebral Compression Fractures. The VERTOS Study
AJNR Am J Neuroradiol 2007;28:555-60 [Abstract] [Full Text] [Figures Only] [PDF]
A randomized prospective trial of vertebroplasty versus optimal pain medication (OPM), this study intended to follow the cohorts for a year but was changed as almost all patients on OPM crossed over to vertebroplasty at 2 weeks. Analysis of the data at 2 weeks demonstrated that pain relief and improvement in mobility, function, and stature after vertebroplasty is significantly better when compared with OPM.
A. Hiwatashi and P.L. Westesson
Vertebroplasty for Osteoporotic Fractures with Spinal Canal Compromise
AJNR Am J Neuroradiol 2007;28:690-92 [Abstract] [Full Text] [Figures Only] [PDF]
This paper reviewed the treatment of vertebral fractures with canal compromise caused by retropulsion and concluded that these could be treated with vertebroplasty safely and efficaciously with improved vertebral height, decreased wedge angle, and no further retropulsion.
M.I. Syed, N.A. Patel, S. Jan, A. Shaikh, B. Grunden, and K. Morar
Symptomatic Refractures after Vertebroplasty in Patients with Steroid-Induced Osteoporosis
AJNR Am J Neuroradiol 2006;27:1938-43 [Abstract] [Full Text] [Figures Only] [PDF]
This paper studied refracture rates in 2 vertebroplasty-treated cohorts—one with primary osteoporosis and one with steroid-induced osteoporosis—and described an increased fracture rate at 1 year for the steroid group (37.8% vs 20.6%), with a predilection towards refracture in the thoracic spine and a trend toward refracture at higher steroid doses.
C.A. Koch, K.F. Layton, and D.F. Kallmes
Outcomes of Patients Receiving Long-Term Corticosteroid Therapy Who Undergo Percutaneous Vertebroplasty
AJNR Am J Neuroradiol 2007;28:563-66 [Abstract] [Full Text] [Figures Only] [PDF]
This paper compared the postvertebroplasty clinical outcomes in patients with primary osteoporosis and patients with steroid-induced osteoporosis, showing equivalent efficacy of the procedure out to 2 years. Interestingly, there was no difference in refracture rate between the 2 populations (29.0% vs 29.4%).
Andrew T. Trout, Leigh A. Gray, and David F. Kallmes
Vertebroplasty in the Inpatient Population
AJNR Am J Neuroradiol 2005;26:1629-33 [Abstract] [Full Text] [Figures Only] [PDF]
This retrospective study of patients admitted for pain control from vertebral fractures concluded that percutaneous vertebroplasty facilitated a rapid hospital discharge and as well as long-term improvement in patients admitted for refractory pain.
Huy M. Do, Brian S. Kim, Mary L. Marcellus, Lisa Curtis, and Michael P. Marks Prospective Analysis of Clinical Outcomes after Percutaneous Vertebroplasty for Painful Osteoporotic Vertebral Body Fractures
AJNR Am J Neuroradiol 2005;26:1623-28 [Abstract] [Full Text] [Figures Only] [PDF]
The first prospective investigation of vertebroplasty outcomes, this study showed statistically significant clinical benefit in pain, analgesic use, activity level, and SF-36 scales 1 month following vertebroplasty, with continued benefit shown on the SF-36 scale at long-term follow-up.
John R. Gaughen, Jr, Mary E. Jensen, Patricia A. Schweickert, William F. Marx, and David F. Kallmes
The Therapeutic Benefit of Repeat Percutaneous Vertebroplasty at Previously Treated Vertebral Levels
AJNR Am J Neuroradiol 2002;23:1657-61 [Abstract] [Full Text] [Figures Only] [PDF]
This study identified 6 occurrences where new pain was associated with continued fracture of a previously treated level and in which repeat vertebroplasty resulted in significant improvement in 5 out of 6 cases, demonstrating that, though rarely needed, repeat vertebroplasty at a single level is safe and efficacious.
Timothy J. Kaufmann, Mary E. Jensen, Patricia A. Schweickert, William F. Marx, and David F. Kallmes
Age of Fracture and Clinical Outcomes of Percutaneous Vertebroplasty
AJNR Am J Neuroradiol 2001;22:1860-63 [Abstract] [Full Text] [PDF]
This retrospective study of 75 patients with compression fractures and suffering from back pain for a mean of 19 weeks (range: 1-104 weeks) showed the efficacy of vertebroplasty across a wide range of fracture ages, though selection bias may have played a role in that patients were treated based upon the presence of positive imaging studies, primarily MR and nuclear medicine.
Clinical Outcomes (Malignant):
R.J. McDonald, A.T. Trout, L.A. Gray, A. Dispenzieri, K.R. Thielen, and D.F. Kallmes
Vertebroplasty in Multiple Myeloma: Outcomes in a Large Patient Series
AJNR Am J Neuroradiol 2008;29:642-48 originally published online on January 17 2008, 10.3174/ajnr.A0918 [Abstract] [Full Text] [Figures Only] [PDF]
This retrospective review of 67 multiple myeloma patients demonstrated statistically significant improvement in pain and mobility, decrease in narcotic use, and improved scoring on a disability scale following vertebroplasty, with no symptomatic complications. The authors also describe 3 distinct pretreatment MR imaging patterns in this cohort.
V. Calmels, J.-N. Vallée, M. Rose, and J. Chiras
Osteoblastic and Mixed Spinal Metastases: Evaluation of the Analgesic Efficacy of Percutaneous Vertebroplasty
AJNR Am J Neuroradiol 2007;28:570-74 [Abstract] [Full Text] [Figures Only] [PDF]
This study of 103 patients with malignant compression fractures demonstrated significant analgesic efficacy durable to 6 months, with the filling quality (>67% vertebral volume), but not the fill volume, associated with the best results.
Clinical Outcomes (Other):
E.M. Knavel, K.R. Thielen, and D.F. Kallmes
Vertebroplasty for the Treatment of Traumatic Nonosteoporotic Compression Fractures
AJNR Am J Neuroradiol 2009;30:323-27 originally published online on November 27 2008, 10.3174/ajnr.A1356 [Abstract] [Full Text] [Figures Only] [PDF]
This paper was the first to specifically address the use of vertebroplasty in traumatic fractures that are neither osteoporotic nor malignant, with the clinical outcomes and complications similar to those seen in the treatment of “traditional” fractures, though lower than usual PMMA injection volumes were noted in this group (average: 2.3 cc).
C.T. Whitlow, B.J. Mussat-Whitlow, C.W.T. Mattern, M.D. Baker, and P.P. Morris
Sacroplasty versus Vertebroplasty: Comparable Clinical Outcomes for the Treatment of Fracture-Related Pain
AJNR Am J Neuroradiol 2007;28:1266-70 [Abstract] [Full Text] [Figures Only] [PDF]
This retrospective study raised awareness of a little-known technique when it compared the clinical outcomes of patients treated for sacral insufficiency fractures with sacroplasty to a control group of vertebroplasty patients, and found similar improvements in pain, mobility, and ability to perform activities of daily living that were durable at 1.5 years.
Position Statement:
M.E. Jensen, J.K. McGraw, J.F. Cardella, and J.A. Hirsch
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
AJNR Am J Neuroradiol 2007;28:1439-43 [Full Text] [PDF]
This collaborative position statement vocalized the multiple specialty societies’ belief that, based upon the available scientific data, vertebroplasty and kyphoplasty are safe, efficacious, and durable procedures when utilized in appropriate patients and performed in accordance with published standards, and that use of vertebral augmentation in patients who have failed medical therapy is preferable over continued “conservative care.”
