Medical Policy Percutaneous Vertebroplasty and Sacroplasty

Transcription

1 Medical Policy Percutaneous Vertebroplasty and Sacroplasty Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description References Authorization Information Policy History Policy Number: 484 BCBSA Reference Number: Related Policies Percutaneous Kyphoplasty, #485 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity Percutaneous vertebroplasty may be MEDICALLY NECESSARY for the treatment of: Symptomatic osteoporotic vertebral s that have failed to respond to conservative treatment (e.g., analgesics, physical therapy and rest) for at least 6 weeks, or Severe pain due to osteolytic lesions of the spine related to multiple myeloma or metastatic malignancies And when 1 : There is a high degree of certainty through targeted, documented physical exam and ancillary studies (e.g., x-ray, MRI, CT, fluoroscopy, bone scan), that the pain is being caused by a non-healing, AND The procedure is not being performed on a prophylactic basis, either for osteoporosis of the spine or chronic back pain, even if associated with old, healed compression (s). Percutaneous vertebroplasty is INVESTIGATIONAL for all other indications, including use in acute vertebral s due to osteoporosis or trauma. Percutaneous sacroplasty is INVESTIGATIONAL for all indications, including use in sacral insufficiency s due to osteoporosis and spinal lesions due to metastatic malignancies or multiple myeloma. Medicare HMO Blue SM and Medicare PPO Blue SM Members Indications: Radiographic studies to identify the, estimate the duration of the, define the anatomy, and assess for posterior vertebral body wall deficiency should be part of preoperative planning for vertebroplasty or vertebral augmentation surgery. Lateral radiographs are essential for planning the trajectory of any percutaneous procedure. MRI and bone scan have proven to be useful in determining 1

2 the acuity of a vertebral compression. A pathologic is defined as "one due to weakening of the bone structure by pathologic processes, such as neoplasia, osteomalacia, osteomyelitis, and other disease." They are also called "secondary s and spontaneous s" (Dorland's Illustrated Medical Dictionary 2000; 29th edition). Vertebral compression s due to osteoporosis are considered pathologic s. A "recent" compression is defined as one which demonstrates uptake on a bone scan or exhibits increased intensity on fluid-sensitive MRI sequences. The principal indications for percutaneous vertebroplasty include: An osteoporotic compression of the lumbar or thoracic vertebrae with persistent debilitating pain that has not responded to accepted standard medical treatment generally within six (6) weeks to three months; Osteolytic metastasis with severe back pain related to a destruction of the vertebral body; Multiple myeloma with severe back pain related to a destruction of the vertebral body; Painful and/or aggressive vertebral hemangiomas (or eosinophilic granulomas of the spine); Painful vertebral associated with osteonecrosis (Kummell Disease); and Reinforcement, or stabilization, of vertebral body prior to surgery. The principal indications for percutaneous vertebral augmentation include: A "recent" osteoporotic compression of the lumbar or thoracic vertebrae with persistent debilitating pain that has not responded to accepted standard medical treatment; and/or Osteolytic vertebral collapse secondary to multiple myeloma or osteolytic metastatic disease causing persisting or progressive pain. Limitations: Neither percutaneous vertebroplasty, nor percutaneous vertebral augmentation, are to be considered prophylactic procedures for osteoporosis of the spine. Neither percutaneous vertebroplasty, nor percutaneous vertebral augmentation should be used for chronic back pain of long-standing duration, even if associated with old compression s, unless pain is localized to a specific chronic and medical therapy has failed. The decision for treatment should be multidisciplinary and consider such factors as the extent of disease, the underlying etiology, the spinal level involved, the severity of the pain, the nature of any neurologic dysfunction, the outcome of any previous non-invasive treatment attempts, and the general state of the patient s health. Absolute contraindications to both percutaneous vertebroplasty and vertebral augmentation procedures include: Any existing uncorrected coagulopathy or anticoagulation therapy; A known allergy to any materials used in the procedure such as the contrast media or bone cement; Ongoing local or systemic infection; Retropulsed bone fragments resulting in spinal canal compromise and myopathy; and Spinal canal compromise secondary to tumor resulting in myelopathy. Relative contraindications to percutaneous vertebroplasty include: Significant vertebral collapse (i.e., vertebra reduced to less than one-third [l/3] of its original height); Neurologic symptoms related to the compression of the vertebrae; Radiculopathy in excess of vertebral pain caused by a compressive syndrome unrelated to vertebral collapse; Asymptomatic retropulsion of a fragment causing significant spinal canal compromise; Asymptomatic tumor extension into the epidural space; and/or Extensive vertebral destruction (extreme caution must be used in these patients during cement injection to prevent new or further neurologic compression that might result from leakage of the acrylic polymer into the epidural space). 2

3 Relative contraindications to percutaneous vertebral augmentation include: Painful benign neoplasms; Fractures caused by high-velocity injury; or Other causes of disabling back pain not due to acute. Local Coverage Determination (LCD): Vertebroplasty and Vertebral Augmentation (Percutaneous) (L26439) vanced&bc=kaaaaagaiaaaaa%3d%3d& Prior Authorization Information See below for situations where prior authorization may be required or may not be required. Yes indicates that prior authorization is required. No indicates that prior authorization is not required. Outpatient Commercial Managed Care (HMO and POS) Yes Yes Commercial PPO and Indemnity Yes Yes Medicare HMO Blue SM Yes Yes Medicare PPO Blue SM Yes Yes Inpatient CPT Codes / HCPCS Codes / ICD-9 Codes The following codes are included below for informational purposes. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. Please refer to the member s contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member. A draft of future ICD-10 Coding related to this document, as it might look today, is included below for your reference. Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable. CPT Codes CPT codes: Code Description Percutaneous vertebroplasty (bone biopsy included when performed), one vertebral body, unilateral or bilateral injection; thoracic Percutaneous vertebroplasty (bone biopsy included when performed), one vertebral body, unilateral or bilateral injection; lumbar Percutaneous vertebroplasty (bone biopsy included when performed); each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure) Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under CT guidance 0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles 0201T Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles 3

4 HCPCS Codes HCPCS codes: S2360 S2361 Code Description Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; cervical Each additional cervical vertebral body (list separately in addition to code for primary procedure) ICD-9 Diagnosis Codes ICD-9-CM diagnosis codes: Code Description Malignant neoplasm of vertebral column, excluding sacrum and coccyx Secondary malignant neoplasm of bone and bone marrow Multiple myeloma, without mention of having achieved remission Multiple myeloma, in remission Multiple myeloma, in relapse Hemangioma of other sites Neoplasm of uncertain behavior of plasma cells Neoplasm related pain (acute) (chronic) Pathologic of vertebrae ICD-9 Procedure Codes ICD-9-CM procedure codes: Code Description Percutaneous vertebroplasty Percutaneous vertebral augmentation ICD-10 Diagnosis Codes ICD-10-CM Diagnosis codes: Code Description C41.2 Malignant neoplasm of vertebral column C79.51 Secondary malignant neoplasm of bone C79.52 Secondary malignant neoplasm of bone marrow C90.00 Multiple myeloma not having achieved remission C90.01 Multiple myeloma in remission C90.02 Multiple myeloma in relapse D18.09 Hemangioma of other sites D47.Z9 Other specified neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue G89.3 Neoplasm related pain (acute) (chronic) M48.50xA Collapsed vertebra, not elsewhere classified, site unspecified, initial encounter for M48.50xD Collapsed vertebra, not elsewhere classified, site unspecified, subsequent encounter for with routine healing M48.50xG Collapsed vertebra, not elsewhere classified, site unspecified, subsequent encounter for with delayed healing M48.50xS Collapsed vertebra, not elsewhere classified, site unspecified, sequela of M48.51xA Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, initial encounter for 4

5 M48.51xD M48.51xG M48.51xS M48.52xA M48.52xD M48.52xG M48.52xS M48.53xA M48.53xD M48.53xG M48.53xS M48.54xA M48.54xD M48.54xG M48.54xS M48.55xA M48.55xD M48.55xG M48.55xS M48.56xA M48.56xD M48.56xG M48.56xS M48.57xA M48.57xD M48.57xG M48.57xS M48.58xA M48.58xD M48.58xG Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, subsequent encounter for with routine healing Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, subsequent encounter for with delayed healing Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, sequela of Collapsed vertebra, not elsewhere classified, cervical region, initial encounter for Collapsed vertebra, not elsewhere classified, cervical region, subsequent encounter for with routine healing Collapsed vertebra, not elsewhere classified, cervical region, subsequent encounter for with delayed healing Collapsed vertebra, not elsewhere classified, cervical region, sequela of Collapsed vertebra, not elsewhere classified, cervicothoracic region, initial encounter for Collapsed vertebra, not elsewhere classified, cervicothoracic region, subsequent encounter for with routine healing Collapsed vertebra, not elsewhere classified, cervicothoracic region, subsequent encounter for with delayed healing Collapsed vertebra, not elsewhere classified, cervicothoracic region, sequela of Collapsed vertebra, not elsewhere classified, thoracic region, initial encounter for Collapsed vertebra, not elsewhere classified, thoracic region, subsequent encounter for with routine healing Collapsed vertebra, not elsewhere classified, thoracic region, subsequent encounter for with delayed healing Collapsed vertebra, not elsewhere classified, thoracic region, sequela of Collapsed vertebra, not elsewhere classified, thoracolumbar region, initial encounter for Collapsed vertebra, not elsewhere classified, thoracolumbar region, subsequent encounter for with routine healing Collapsed vertebra, not elsewhere classified, thoracolumbar region, subsequent encounter for with delayed healing Collapsed vertebra, not elsewhere classified, thoracolumbar region, sequela of Collapsed vertebra, not elsewhere classified, lumbar region, initial encounter for Collapsed vertebra, not elsewhere classified, lumbar region, subsequent encounter for with routine healing Collapsed vertebra, not elsewhere classified, lumbar region, subsequent encounter for with delayed healing Collapsed vertebra, not elsewhere classified, lumbar region, sequela of Collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for Collapsed vertebra, not elsewhere classified, lumbosacral region, subsequent encounter for with routine healing Collapsed vertebra, not elsewhere classified, lumbosacral region, subsequent encounter for with delayed healing Collapsed vertebra, not elsewhere classified, lumbosacral region, sequela of Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, initial encounter for Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, subsequent encounter for with routine healing Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, subsequent encounter for with delayed healing 5

6 M48.58xS M80.08xA M80.08xD M80.08xG M80.08xK M80.08xP M80.08xS M80.88xA M80.88xD M80.88xG M80.88xK M80.88xP M80.88xS M84.48xA M84.48xD M84.48xG M84.48xK M84.48xP M84.48xS M84.58xA M84.58xD M84.58xG M84.58xK M84.58xP M84.58xS M84.68xA M84.68xD M84.68xG M84.68xK M84.68xP M84.68xS Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, sequela of Age-related osteoporosis with current pathological, vertebra(e), initial encounter for Age-related osteoporosis with current pathological, vertebra(e), subsequent encounter for with routine healing Age-related osteoporosis with current pathological, vertebra(e), subsequent encounter for with delayed healing Age-related osteoporosis with current pathological, vertebra(e), subsequent encounter for with nonunion Age-related osteoporosis with current pathological, vertebra(e), subsequent encounter for with malunion Age-related osteoporosis with current pathological, vertebra(e), sequela Other osteoporosis with current pathological, vertebra(e), initial encounter for Other osteoporosis with current pathological, vertebra(e), subsequent encounter for with routine healing Other osteoporosis with current pathological, vertebra(e), subsequent encounter for with delayed healing Other osteoporosis with current pathological, vertebra(e), subsequent encounter for with nonunion Other osteoporosis with current pathological, vertebra(e), subsequent encounter for with malunion Other osteoporosis with current pathological, vertebra(e), sequela Pathological, other site, initial encounter for Pathological, other site, subsequent encounter for with routine healing Pathological, other site, subsequent encounter for with delayed healing Pathological, other site, subsequent encounter for with nonunion Pathological, other site, subsequent encounter for with malunion Pathological, other site, sequela Pathological in neoplastic disease, other specified site, initial encounter for Pathological in neoplastic disease, other specified site, subsequent encounter for with routine healing Pathological in neoplastic disease, other specified site, subsequent encounter for with delayed healing Pathological in neoplastic disease, other specified site, subsequent encounter for with nonunion Pathological in neoplastic disease, other specified site, subsequent encounter for with malunion Pathological in neoplastic disease, other specified site, sequela Pathological in other disease, other site, initial encounter for Pathological in other disease, other site, subsequent encounter for with routine healing Pathological in other disease, other site, subsequent encounter for with delayed healing Pathological in other disease, other site, subsequent encounter for with nonunion Pathological in other disease, other site, subsequent encounter for with malunion Pathological in other disease, other site, sequela 6

7 ICD-10 Procedure Codes ICD-10-PCS procedure codes: 0PU33JZ 0PS33ZZ 0PS43ZZ 0PU34JZ 0PU43JZ 0PU44JZ 0QS03ZZ 0QS13ZZ 0QSS3ZZ 0QU03JZ 0QU04JZ 0QU13JZ 0QU14JZ 0QUS3JZ Code Description Supplement Cervical Vertebra with Synthetic Substitute, Percutaneous Approach Reposition Cervical Vertebra, Percutaneous Approach Reposition Thoracic Vertebra, Percutaneous Approach Supplement Cervical Vertebra with Synthetic Substitute, Percutaneous Endoscopic Approach Supplement Thoracic Vertebra with Synthetic Substitute, Percutaneous Approach Supplement Thoracic Vertebra with Synthetic Substitute, Percutaneous Endoscopic Approach Reposition Lumbar Vertebra, Percutaneous Approach Reposition Sacrum, Percutaneous Approach Reposition Coccyx, Percutaneous Approach Supplement Lumbar Vertebra with Synthetic Substitute, Percutaneous Approach Supplement Lumbar Vertebra with Synthetic Substitute, Percutaneous Endoscopic Approach Supplement Sacrum with Synthetic Substitute, Percutaneous Approach Supplement Sacrum with Synthetic Substitute, Percutaneous Endoscopic Approach Supplement Coccyx with Synthetic Substitute, Percutaneous Approach Description Percutaneous vertebroplasty (PVP) is an interventional radiology technique involving the fluoroscopically guided injection of polymethylmethacrylate (PMMA) through a needle inserted into a weakened vertebral body. The technique has been investigated as an option to provide mechanical support and symptomatic relief in patients with osteoporotic vertebral compression or in those with osteolytic lesions of the spine, i.e., multiple myeloma or metastatic malignancies. Percutaneous vertebroplasty has also been investigated as an adjunct to surgery for aggressive vertebral body hemangiomas, as a technique to limit blood loss related to surgery. The technique has been used in all levels of the vertebrae (i.e., cervical, thoracic, and lumbar). It has been proposed that PVP may provide an analgesic effect through mechanical stabilization of a d or otherwise weakened vertebral body. However, other possible mechanisms of effect have been postulated, including thermal damage to intraosseous nerve fibers, since PMMA undergoes a heatreleasing (exothermic) reaction during its hardening process. Sacroplasty evolved from the treatment of insufficiency s in the thoracic and lumbar vertebrae with vertebroplasty. The procedure, essentially identical, entails guided injection of PMMA through a needle inserted into the zone. It is most often described as a minimally invasive procedure employed as an alternative to conservative management for sacral insufficiency s (SIFs). SIFs are the consequence of excessive stress on weakened bone and are often the cause of low back pain among the elderly. Osteoporosis is the most common risk factor for SIF. Examples of PMMA bone cements for use with vertebroplasty include Spine-Fix Biomimetic Bone Cement from The OrthoMedix Group, Inc. and Osteopal V from Heraeus. All percutaneous kyphoplasty and sacroplasty are considered investigational regardless of the commercial name, the manufacturer or FDA approval status except when used for the medically necessary indications that are consistent with the policy statement. Summary In 2008 after consideration of the uniform clinical input, it was concluded that although the scientific evidence does not permit conclusions about the impact on health outcomes and although comparative studies with long-term outcomes were lacking, numerous case series, including large prospective reports, 7

8 consistently show that vertebroplasty may alleviate pain and improve function in patients with vertebral s who fail to respond to conservative treatment (at least 6 weeks with analgesics, physical therapy, and rest). Given the absence of alternative treatment options and the morbidity associated with extended bed rest, vertebroplasty may be considered a reasonable treatment option in patients with vertebral s who fail to improve after 6 weeks of conservative therapy. After reviewing the literature, there is insufficient evidence to permit conclusions on the use of vertebroplasty for an acute. The Klazen et al. trial is a well-done study, whose results should be replicated and verified. Sacroplasty is under development. Varying techniques, patient indications, and small numbers of treated patients leaves uncertainty regarding the impact of sacroplasty on health outcomes and does not permit conclusion on its use for sacral insufficiency s or other indication. Therefore sacroplasty is considered investigational. Policy History Date Action 7/2014 New references added from BCBSA National medical policy. 6/2014 Updated Coding section with ICD10 procedure and diagnosis codes, effective 10/ /2014 Local Coverage Determination (LCD) for Percutaneous Vertebroplasty/Percutaneous Augmentation (L11417) retired and replaced by LCD L26439 Vertebroplasty and Vertebral Augmentation (Percutaneous). Effective October 25, /2013 New references from BCBSA National medical policy. 11/2011- Medical policy ICD 10 remediation: Formatting, editing and coding updates. 4/2012 1/2012 Reviewed - Medical Policy Group - Neurology and Neurosurgery. 12/1/2011 BCBSA National medical policy review. Changes to policy statements. 1/2011 Reviewed - Medical Policy Group - Neurology and Neurosurgery. 7/2010 Reviewed - Medical Policy Group - Orthopedics, Rehabilitation Medicine and Rheumatology. 6/2010 BCBSA National medical policy review. Changes to policy statements. 1/2010 Reviewed - Medical Policy Group - Neurology and Neurosurgery. 7/2009 Reviewed - Medical Policy Group - Orthopedics, Rehabilitation Medicine and Rheumatology. 6/1/2009 New policy, effective 6/1/2009, describing covered and non-covered indications. 11/2008 BCBSA National medical policy review. 7/2008 Reviewed - Medical Policy Group - Orthopedics, Rehabilitation Medicine and Rheumatology. 1/2008 Reviewed - Medical Policy Group - Neurology and Neurosurgery. 1/2007 Reviewed - Medical Policy Group - Neurology and Neurosurgery. Information Pertaining to All Blue Cross Blue Shield Medical Policies Click on any of the following terms to access the relevant information: Medical Policy Terms of Use 8

9 Managed Care Guidelines Indemnity/PPO Guidelines Clinical Exception Process Medical Technology Assessment Guidelines References 1. Dehdashti AR, Martin JB, Jean B et al. PMMA cementoplasty in symptomatic metastatic lesions of the S1 vertebral body. Cardiovasc Intervent Radiol 2000; 23(3): Marcy PY, Palussiere J, Descamps B et al. Percutaneous cementoplasty for pelvic bone metastasis. Support Care Cancer 2000; 8(6): Aretxabala I, Fraiz E, Perez-Ruiz F et al. Sacral insufficiency s. High association with pubic rami s. Clin Rheumatol 2000; 19(5): Leroux JL, Denat B, Thomas E et al. Sacral insufficiency s presenting as acute low-back pain. Biomechanical aspects. Spine (Phila Pa 1976) 1993; 18(16): Newhouse KE, el-khoury GY, Buckwalter JA. Occult sacral s in osteopenic patients. J Bone Joint Surg Am 1992; 74(10): Gotis-Graham I, McGuigan L, Diamond T et al. Sacral insufficiency s in the elderly. J Bone Joint Surg Br 1994; 76(6): Lourie H. Spontaneous osteoporotic of the sacrum. An unrecognized syndrome of the elderly. JAMA 1982; 248(6): Lin J, Lachmann E, Nagler W. Sacral insufficiency s: a report of two cases and a review of the literature. J Womens Health Gend Based Med 2001; 10(7): Blue Cross and Blue Shield Technology Evaluation Center (TEC). Percutaneous Vertebroplasty. TEC Assessments 2000; Volume 15, Tab Blue Cross and Blue Shield Technology Evaluation Center (TEC). Percutaneous vertebroplasty for vertebral s caused by osteoporosis, malignancy, or hemangioma. TEC Assessments 2004; Volume 19, Tab Blue Cross and Blue Shield Technology Evaluation Center (TEC). Percutaneous vertebroplasty for vertebral s caused by osteoporosis or malignancy. TEC Assessments 2005; Volume 20, Tab Blue Cross and Blue Shield Technology Evaluation Center (TEC). Percutaneous vertebroplasty or kyphoplasty for vertebral s caused by osteoporosis or malignancy. TEC Assessments 2008; Volume 23, Tab Blue Cross and Blue Shield Technology Evaluation Center (TEC). Percutaneous vertebroplasty or kyphoplasty for vertebral s caused by osteoporosis. TEC Assessments 2009; Volume 24, Tab Blue Cross and Blue Shield Technology Evaluation Center (TEC). Percutaneous vertebroplasty for vertebral s caused by osteoporosis. TEC Assessments 2010; Volume 25, Tab Layton KF, Thielen KR, Koch CA et al. Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. AJNR Am J Neuroradiol 2007; 28(4): Buchbinder R, Osborne RH, Ebeling PR et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral s. N Engl J Med 2009; 361(6): Kallmes DF, Comstock BA, Heagerty PJ et al. A randomized trial of vertebroplasty for osteoporotic spinal s. N Engl J Med 2009; 361(6): Senn S. Statistical Issues in Drug Development. NY: Wiley and Sons; Masala S, Massari F, Assako OP et al. Is 3T-MR spectroscopy a predictable selection tool in prophylactic vertebroplasty? Cardiovasc Intervent Radiol 2010; 33(6): Grotle M, Brox JI, Vollestad NK. Concurrent comparison of responsiveness in pain and functional status measurements used for patients with low back pain. Spine (Phila Pa 1976) 2004; 29(21):E Ostelo RW, Deyo RA, Stratford P et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 2008; 33(1): Comstock BA, Sitlani CM, Jarvik JG et al. Investigational vertebroplasty safety and efficacy trial (INVEST): patient-reported outcomes through 1 year. Radiology 2013; 269(1):

10 23. Staples MP, Kallmes DF, Comstock BA et al. Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials: meta-analysis. BMJ 2011; 343:d Klazen CA, Lohle PN, de Vries J et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression s (Vertos II): an open-label randomised trial. Lancet 2010; 376(9746): Venmans A, Klazen CA, Lohle PN et al. Natural History of Pain in Patients with Conservatively Treated Osteoporotic Vertebral Compression Fractures: Results from VERTOS II. AJNR Am J Neuroradiol Farrokhi MR, Alibai E, Maghami Z. Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression s. J Neurosurg Spine 2011; 14(5): Rousing R, Andersen MO, Jespersen SM et al. Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral s: three-months follow-up in a clinical randomized study. Spine (Phila Pa 1976) 2009; 34(13): Voormolen MH, Mali WP, Lohle PN et al. Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression s. The VERTOS study. AJNR Am J Neuroradiol 2007; 28(3): Diamond TH, Bryant C, Browne L et al. Clinical outcomes after acute osteoporotic vertebral s: a 2-year non-randomised trial comparing percutaneous vertebroplasty with conservative therapy. Med J Aust 2006; 184(3): Edidin AA, Ong KL, Lau E et al. Mortality risk for operated and nonoperated vertebral patients in the medicare population. J Bone Miner Res 2011; 26(7): Yi X, Lu H, Tian F et al. Recompression in new levels after percutaneous vertebroplasty and kyphoplasty compared with conservative treatment. Arch Orthop Trauma Surg 2014; 134(1): Chew C, Craig L, Edwards R et al. Safety and efficacy of percutaneous vertebroplasty in malignancy: a systematic review. Clin Radiol 2011; 66(1): Wang LJ, Yang HL, Shi YX et al. Pulmonary cement embolism associated with percutaneous vertebroplasty or kyphoplasty: a systematic review. Orthop Surg 2012; 4(3): Frey ME, Depalma MJ, Cifu DX et al. Percutaneous sacroplasty for osteoporotic sacral insufficiency s: a prospective, multicenter, observational pilot study. Spine J 2008; 8(2): Kortman K, Ortiz O, Miller T et al. Multicenter study to assess the efficacy and safety of sacroplasty in patients with osteoporotic sacral insufficiency s or pathologic sacral lesions. J Neurointerv Surg 2013; 5(5): Dougherty RW, McDonald JS, Cho YW et al. Percutaneous sacroplasty using CT guidance for pain palliation in sacral insufficiency s. J Neurointerv Surg 2014; 6(1): Zaman FM, Frey M, Slipman CW. Sacral stress s. Curr Sports Med Rep 2006; 5(1): Denis F, Davis S, Comfort T. Sacral s: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 1988; 227: ACR-ASNR-ASSR=SIR-SNIS. Practice guideline for the performance of vertebral augmentation Available online at: Last accessed February, Barr JD, Jensen ME, Hirsch JA et al. Position statement on percutaneous vertebral augmentation: a consensus statement developed by the Society of Interventional Radiology (SIR), American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS), American College of Radiology (ACR), American Society of Neuroradiology (ASNR), American Society of Spine Radiology (ASSR), Canadian Interventional Radiology Association (CIRA), and the Society of NeuroInterventional Surgery (SNIS). J Vasc Interv Radiol 2014; 25(2): Baerlocher MO, Saad WE, Dariushnia S et al. Quality improvement guidelines for percutaneous vertebroplasty. J Vasc Interv Radiol 2014; 25(2): American College of Radiology. Management of Compression Fractures Available online at: Last accessed February, American Academy of Orthopaedic Surgeons (AAOS). Clinical Practice Guideline Treatment of osteoporotic spinal compression s Last accessed February,

11 44. National Institute for Health and Care Excellence (NICE). IPG 12: Percutaneous Vertebroplasty Available online at: Last accessed February, National Institute for Health and Care Excellence (NICE). TA 279 Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression s Available online at: Last accessed February, National Institute for Health and Care Excellence (NICE). CG75 Metastatic spinal cord compression: Diagnosis and management of adults at risk of and with metastatic spinal cord compression Available online at: Last accessed February,