title: Critique of the analysis of UpToDate.com on the treatment of painful vertebral compression fractures: time to update UpToDate.
abstract: The treatment of painful vertebral compression fractures has changed substantially since the introduction of vertebroplasty in the mid-1980s and balloon kyphoplasty in the late 1990s. Both procedures were widely accepted with the vertebral fractures treated reaching 150,000 per annum in 2009 prior to the publication of 2 randomized controlled trials comparing vertebroplasty with a sham treatment published in the New England Journal of Medicine in August 2009. Since then, there has been a flood of information on vertebral augmentation and balloon kyphoplasty. It is worth evaluating this information especially because it relates to current recommendations that are often followed blindly by medical and administrative groups unfamiliar with either the procedure or the high level of evidence surrounding vertebral augmentation. To streamline the evaluation of some current recommendations, we limited the analysis to the recommendations found on UpToDate.com. This Web site is an evidence-based, peer-reviewed source of information available for patients, doctors, health insurance companies, and population-based medical decision-making.
authors.affiliation: From Radiology Services (D.P.B.), Clinical Radiology of Oklahoma, Musculoskeletal Imaging and Interventional, Oklahoma City, Oklahoma db@clinrad.org.
authors.forename: D P
authors.initials: DP
authors.lastname: Beall
authors.affiliation: Interventional Spine and Pain Medicine (W.P.M.), Holy Cross Hospital, Fort Lauderdale, Florida.
authors.forename: W P
authors.initials: WP
authors.lastname: McRoberts
authors.affiliation: Department of Orthopaedic Surgery (S.H.B.), University of California San Francisco, San Francisco, California.
authors.forename: S H
authors.initials: SH
authors.lastname: Berven
authors.affiliation: Tyler Neurosurgery (J.T.L.), Tyler, Texas.
authors.forename: J T
authors.initials: JT
authors.lastname: Ledlie
authors.affiliation: Departments of Radiology and Surgery (S.M.T.), Medical College of Wisconsin, Froedtert East Clinic, Milwaukee, Wisconsin.
authors.forename: S M
authors.initials: SM
authors.lastname: Tutton
authors.affiliation: Department of Radiology (B.P.P.), University of Oklahoma College of Medicine, Edmond, Oklahoma.
authors.forename: B P
authors.initials: BP
authors.lastname: Parsons
mesh_terms: D019317:Evidence-Based Medicine; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D033181:Information Dissemination; D020407:Internet; D058498:Kyphoplasty; D016103:Spinal Fractures / Q000601:surgery*; D016896:Treatment Outcome; D054854:Vertebroplasty