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Trends in vertebral augmentation for spinal fractures in myeloma patients: a 2002–2012 population-based study using a large national cancer registry
  1. Falgun H Chokshi1,
  2. David H Howard2,
  3. Jeffrey G Jarvik3,
  4. Richard Duszak Jr1
  1. 1Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Department of Health Policy and Management, Rollins School of Public Health (Emory), Atlanta, Georgia, USA
  3. 3Departments of Radiology, Neurological Surgery and Health Services, University of Washington School of Medicine, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Falgun H Chokshi,Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322, USA; falgun.chokshi{at}


Purpose To evaluate temporal trends and factors associated with vertebral augmentation use in myeloma patients with spinal fractures from 2002 to 2012.

Methods This retrospective cohort study used the Surveillance, Epidemiology and End Results (SEER)-Medicare claims database for 2002 through 2012. We included patients age ≥66 years with myeloma and spinal fractures. First, we evaluated receipt of vertebral augmentation. Second, multivariate logistic regression was used to assess the impact of sociodemographic factors, treatment facility type, and underlying comorbidities on the odds of undergoing vertebral augmentation.

Results Of 4725 myeloma patients with spinal fractures, 653 underwent vertebral augmentation. Procedures increased initially from <1.7% in 2002 to 21.0% (109/520) in 2007, 18.6% (81/435) in 2008, 21.4% (109/509) in 2009, and 17.5% (76/435) in 2011. Patients with a spinal fracture before myeloma diagnosis were twice as likely to undergo vertebral augmentation as patients with fracture after myeloma diagnosis (OR 2.06, 95% CI 1.55 to 2.75). Black patients were half as likely to undergo vertebral augmentation as white patients (OR 0.48, 95% CI 0.34 to 0.68). Patients with 3–5 comorbidities (OR 0.78, 95% CI 0.64 to 0.96) and ≥6 comorbidities (OR 0.69, 95% CI 0.54 to 0.87) were less likely than patients with 0–2 comorbidities to undergo vertebral augmentation.

Conclusions Vertebral augmentation for myeloma patients with spinal fractures peaked between 2007 and 2009 and then declined. Providers may have adopted vertebral augmentation in myeloma patients since its introduction, and potentially modified practice patterns following the publication of trials of vertebral augmentation in patients with osteoporotic spinal fractures.

  • Spine
  • Tumor
  • Malignant

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  • Contributors All authors made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and drafted the work or revised it critically for important intellectual content; and provided final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This work was supported by the Association of University Radiologists (AUR) General Electric Radiology Research Academic Fellowship (GERRAF) Grant. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding source.

  • Competing interests JGJ has the following disclosures: Physiosonix (ultrasound company): founder/stockholder. Healthhelp (utilization review): consultant. Google: consultant. Evidence-Based Neuroimaging Diagnosis and Treatment (Springer): author.

  • Ethics approval Ethics approval was obtained from Emory University Institutional Review Board.

  • Disclaimer This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors.

  • Provenance and peer review Not commissioned; externally peer reviewed.