title: Have referral patterns for vertebroplasty changed since publication of the placebo-controlled trials?
abstract: OBJECTIVE
  Our aim was to determine whether referral patterns and rates of vertebroplasties at the Mayo Clinic have changed after the publication of the INVEST and the Australian Trial. In August of 2009, we performed a retrospective review of patients undergoing vertebroplasties and those patients who were referred for but did not receive vertebroplasties before and after the recently published placebo-controlled vertebroplasty trials.
  
  
  METHODS
  After approval by our local institutional review board, we retrospectively evaluated all patients referred for vertebroplasty between January 5, 2004, and June 2, 2010. We catalogued age, sex, number of treated vertebrae, physician referring the patient for vertebroplasty, and the referring department. We calculated the mean number of referrals per month before and after August 2009, which was the month of publication for both trials. We also calculated rates for specific referring physician types.
  
  
  RESULTS
  During the full study, 1188 patients were referred, of whom 807 underwent treatment at 1378 levels for a total of 943 separate vertebroplasty procedures. The mean number of vertebroplasty referrals per month has dropped significantly from 18.9 ± 5.3 (95% CI, 17.7-20.2) before publication to 11.3 ± 3.1 (95% CI, 9.1-13.5) referrals per month after publication (P=.0001). Before publication, 67.3 ± 14.0% (95% CI, 64.0%-70.7%) of patients referred for vertebroplasty underwent vertebroplasty, compared with 76.0 ± 14.9% (95% CI, 65.4%-86.6%) after publication (P=.11).
  
  
  CONCLUSIONS
  The number of vertebroplasty referrals at our center has decreased significantly since the publication of INVEST and the Australian Trial, yet we continue to offer the procedure to a high proportion of referred patients.
authors.affiliation: College of Saint Benedict/Saint John's University, St. Joseph, Minnesota, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Luetmer
authors.forename: D F
authors.initials: DF
authors.lastname: Kallmes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018849:Controlled Clinical Trials as Topic; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010919:Placebos; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000453:epidemiology* / Q000628:therapy*; D054854:Vertebroplasty / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D010919:Placebos