title: Vertebral Augmentation After Recent Randomized Controlled Trials: A New Rise in Kyphoplasty Volumes.
abstract: OBJECTIVE
  In 2009, the results of two randomized controlled trials refuting the effectiveness of vertebroplasty compared with sham procedures were published in a leading journal. The purpose of the present study was to evaluate the impact of these randomized trials on subsequent volume and utilization rates of vertebral augmentation (VA) in the United States.
  
  
  METHODS
  Using nationwide Medicare Part B databases, Current Procedural Terminology, version 4, codes for thoracic and lumbar vertebroplasty and kyphoplasty were studied from 2006 to 2013 (codes 22520 to 22525). The total volumes of procedures were determined and utilization rates were calculated. Volumes and rates by provider specialty were also studied.
  
  
  RESULTS
  The total volume of VA procedures peaked in 2008 at 101,807 and thereafter fell steadily to 80,940 in 2013. The utilization rates per 100,000 beneficiaries also showed a similar trend. Radiologists performed the largest number of VA procedures in 2013 (33,618 procedures [42%]), followed by orthopedic surgeons (19,886 procedures [25%]). After 2009, vertebroplasty volumes decreased sharply. Kyphoplasty volumes increased in 2011, after an initial decrease in 2010. The divergent trend in the volumes of the two procedures persisted through 2013.
  
  
  CONCLUSIONS
  After the publication of the two trials' results in 2009, vertebroplasty volumes and rates decreased sharply. However, there is an emerging trend toward performing more kyphoplasty procedures, mitigating the decrease in total volume of VA procedures. Radiologists have the strongest role in performing these procedures among all medical specialties.
authors.affiliation: Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: mougnyan.cox@gmail.com.
authors.forename: Mougnyan
authors.initials: M
authors.lastname: Cox
authors.affiliation: Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: David C
authors.initials: DC
authors.lastname: Levin
authors.affiliation: Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Laurence
authors.initials: L
authors.lastname: Parker
authors.affiliation: Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: William
authors.initials: W
authors.lastname: Morrison
authors.affiliation: Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Long
authors.affiliation: Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Rao
mesh_terms: D006801:Humans; D058498:Kyphoplasty / Q000706:statistics & numerical data*; D016345:Medicare Part B; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D014481:United States; D054854:Vertebroplasty / Q000706:statistics & numerical data
keywords: New England Journal of Medicine; VERTOS; Vertebroplasty; kyphoplasty; sham; simulated