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SIR 2025
Pain Management/MSK
Scientific Session
Jaclyn Lundberg, MD
Resident Physician
Hospital of University of Pennsylvania, United States
Srinidhi Shanmugasundaram, MD (she/her/hers)
Resident Physician
Hospital of University of Pennsylvania, United States
Anoop Manjunath, MD
Resident Physician
Hospital of University of Pennsylvania, United States
Timothy W. Clark, MD, FSIR
Professor of Clinical Radiology; Director of Interventional Radiology
University of Pennsylvania; Penn Presbyterian Medical Center, United States
Ansar Z. Vance, MD
Attending Physician
University of Pennsylvania, United States
Vertebral augmentation is increasingly recognized as a valuable procedure for treating acute vertebral compression fractures (VCFs), with the latest guidelines from interventional radiology, orthopedic surgery, and neurosurgery endorsing its use in well selected patients. {Clark, Carli} The objective of this retrospective cohort study was to determine whether hospitalized patients are receiving appropriate standard of care for acute VCFs.
Materials and Methods:
A retrospective review was performed at the study institution of consecutive patients with MR-proven acute VCF and acute back pain from 9/1/2020 to 9/1/2024. Standard of care was determined by Medicare/CMS guidelines which state that vertebral augmentation is considered medically necessary when an MR-proven acute osteoporotic VCF is painful and not responding to non-surgical medical management with several inclusion criteria including: hospitalized patients with a pain score of 8 or outpatient with moderate to severe pain of greater or equal to 5 with worsening pain. For pathologic compression fractures, augmentation is indicated with severe back pain. Exclusion criteria was dictated by CMS guidelines including osteomyelitis, surgical site infection, pregnancy, spinal instability, retropulsion, or neurological deficit.{Hirsch, Barr} Subgroup analysis was performed on patient demographics, opioid requirements , pain scores, treatment, and complication rates.
Results:
Eighty-nine patients (66% female) were evaluated. Fractures were 80% osteoporotic and 20% pathologic. Mean time to vertebral augmentation was 5 months (SD 3.3). Opioids were prescribed in 71% of patients. Mean pain score was 7 +/- 2. Vertebral augmentation was indicated in 65% of patients, however only 45% of patients received standard of care. VCF 1-year mortality was 5%. There was no significant association between receiving standard of care and type of fracture (osteoporotic versus pathologic) (p=0.75). Neither patient sex, type of fracture, nor opioid use showed significant association with receiving standard of care. However, using a logistic regression model, higher pain scores were associated with lower odds of receiving standard of care (p=0.04).
Conclusion:
Despite the proven benefits of lower morbidity and mortality rates, as well as decreased opioid use, clinically-indicated vertebral augmentation is underutilized in patients with acute VCFs.