Elsevier

Surgical Neurology

Volume 71, Issue 5, May 2009, Pages 580-584
Surgical Neurology

Spine
National trends in vertebral augmentation procedures for the treatment of vertebral compression fractures

https://doi.org/10.1016/j.surneu.2008.02.043Get rights and content

Abstract

Background

Vertebral compression fractures represent a serious health care problem. Vertebroplasty and kyphoplasty have been gaining popularity in the treatment of symptomatic compression fractures that are often secondary to osteoporosis or neoplasia.

Methods

We use the NIS database from 1993 through 2004 to examine trends in VCFs. Patients with VCFs were identified using primary diagnostic codes (ICD-9—pathologic vertebral fracture, 733.13) and cross-referenced with ICD-9 procedure codes (ICD-9—VAPs, 78.49; kyphoplasty, 81.66; and vertebroplasty, 81.65).

Results

In 2004, more than 23 000 VAPs were performed nationwide on an inpatient basis for VCFs. This represented a 12 900% increase in the number of procedures performed since 1993. Approximately 60% of patients were female and aged 65 to 84 years. Nearly 60% of vertebroplasties and 25% of kyphoplasties were on patients admitted from the ED. Large-sized hospitals and those hospitals located in the southern United States accounted for most of the cases. The mean LOS was 3.7 days for kyphoplasty and 7.3 days for vertebroplasty. The final discharge disposition, home vs institution (nursing home, rehabilitation), was 50:50 for vertebroplasty and 77:23 for kyphoplasty. The mean hospital charges for both procedures were comparable, and the total “national bill” was ∼$672 million in 2004.

Conclusions

With the continued aging of the population, VCFs represent an increasingly important health care issue. The staggering increase in the number of minimally invasive VAPs performed illustrates the continued adoption of these innovative technologies and early trends in their applications.

Introduction

Vertebral compression fractures represent a tremendous health care problem [4], [7], [9]. Kyphoplasty and vertebroplasty are 2 minimally invasive VAPs (together, will be abbreviated as VAPs) developed for the management of symptomatic VCFs [3], [5], [8].

Vertebral augmentation procedures have been gaining popularity in the treatment of symptomatic VCFs from osteoporotic or neoplastic etiology. The goal of this study was to examine patient demographics and outcomes for kyphoplasty or vertebroplasty on the basis of a large unselected sampling of US clinical practice that represents an unbiased cross-section across the entire country in a single year.

Section snippets

Methods

We used the NIS database, a nationwide database of hospital inpatient stays that represents the largest all-payer inpatient care database [2]. The NIS database contains data from approximately 8 million annual discharges from 1004 hospitals in 37 states [2]. We analyzed data collected from 1993 through 2004 to determine general trends in pathologic VCFs. Patients with pathologic VCFs who were treated with VAPs were identified using the ICD-9 diagnostic code (ICD-9—pathologic vertebral fracture,

Pathologic fractures

For the 11-year period from 1993 to 2004, there was a continued increase in the number of hospitalizations for pathologic vertebral fractures (16.9-18.9/100 000) (Fig. 1A). Even more dramatic was the increase in the number of VAPs performed for the same period, increasing from 182 in 1993 to 23 691 in 2004 (Fig. 1B). The rapid rise in the number of VAPs performed is even more dramatic (182-23 691; 12 900% increase) (Fig. 1B) and clearly outpaces the rise in other major procedures for the same

Discussion

Both vertebroplasty and kyphoplasty are indicated for progressive painful VCFs in the absence of neurologic signs[5], [6], [10]. The rapid rise in the number of VAPs (12 900% increase) performed from 1993 to 2004 outpaces the rate of increase for other major orthopedic procedures (Table 1); yet, only 42% of pathologic VCFs are being treated, leaving enormous room for continued growth.

In general, women account for 80% of the patients with osteoporosis and undergo a rapid loss of bone after

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