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The evidentiary basis of vertebral augmentation: a 2019 update
  1. Reade De Leacy1,
  2. Ronil V Chandra2,3,
  3. John D Barr4,
  4. Allan Brook5,
  5. Alessandro Cianfoni6,
  6. Bassem Georgy7,
  7. Ashu Jhamb8,
  8. Paul N M Lohle9,
  9. Luigi Manfre10,
  10. Stefano Marcia11,
  11. Alexander Venmans9,
  12. Devin Bageac12,
  13. Joshua A Hirsch13
  1. 1Departments of Neurosurgery & Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  2. 2Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia
  3. 3Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
  4. 4Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
  5. 5Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
  6. 6Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
  7. 7San Diego Imaging, Oceanside, California, USA
  8. 8Department of Radiology, St Vincent's Hospital, Melbourne, Victoria, Australia
  9. 9Department of Radiology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
  10. 10Department of Radiology, IOM Mediterranean Oncology Institute, Viagrande, Sicily, Italy
  11. 11Department of Radiology, SS Trinita Hospital, Cagliari, Sardinia, Italy
  12. 12Department of Neurosurgery, Mount Sinai Health System, New York City, New York, USA
  13. 13NeuroInterventional Radiology, MGH, Boston, Massachusetts, USA
  1. Correspondence to Dr Reade De Leacy, Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA; reade.deleacy{at}


No aspect of neurointerventional practice has been associated with as longstanding contention and debate as to its effectiveness as has vertebroplasty (VP). Four blinded randomized controlled trials published since 2009 have demonstrated conflicting results regarding a conferred benefit in pain reduction and functional improvement for patients who undergo VP for osteoporotic vertebral compression fractures. Significant heterogeneity exists between each of these trials, which has resulted in difficulty for interventionalists and surgeons to translate the trial findings into routine clinical practice. In addition, patients and their families are ever more enlightened and enabled via the internet and social media to review both medical literature and websites. Without the proper background and context, their decisions may be lacking appropriate and necessary scientific discussion. This review article summarizes the randomized controlled trial data to date, with particular focus on the aforementioned four blinded studies. We will also evaluate the profound impact of the decrease in vertebral augmentation utilization on short- and long-term patient morbidity and mortality using available national and administrative datasets from both within the USA and internationally. We also consider future trial design to help evaluate this procedure and determine its role in modern neurointerventional practice.

  • spine
  • intervention
  • economics
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  • Twitter @rdeleacymd, @Dr Ashu Jhamb

  • Correction notice Since this article was first published online, the author name Josh has been updated to Joshua.

  • Contributors RDL, RVC, and JAH researched, prepared, and wrote the manuscript. JDB, AB, AC, BG, AJ, PL, LM, SM, AV, and DB aided in data analysis, proof reading, and redrafting the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RDL is a consultant for Cerenovus, Imperative Care and Siemens. AB is a consultant for Medtronic and Stryker. BG is a speaker for Merit Medical. SM is a consultant for Stryker and Techlamed. JAH is a consultant for Medtronic and grant recipient from the Nieman Health Policy Institute.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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