Background: Appropriate treatment choice for osteoporotic vertebral compression fractures
(OVCF) is challenging due to patient heterogeneity. Using the RAND/UCLA method, an
international multidisciplinary expert panel established patient-specific criteria for the choice
between non-surgical management (NSM), vertebroplasty (VP), and balloon kyphoplasty (BKP).
Objectives: To assess the applicability of the appropriateness criteria in real-life practice.
Study Design: Prospective observational study.
Setting: Eight practices of experts who participated in the panel study, including 2
interventional radiologists, one internal medicine specialist, 2 neurosurgeons, and 3 orthopedic/
trauma surgeons. Practices were located in Belgium, Germany, Italy, Switzerland, and the
United Kingdom.
Methods: Using an online data capture program, participants documented the clinical profile
(age, gender, previous VCFs, time since fracture, magnetic resonance imaging (MRI) findings,
evolution of symptoms, impact of symptoms on quality of life, spinal deformity, ongoing
fracture process, and presence of pulmonary dysfunction) and treatment choice for consecutive
patients who consulted them for OVCF.
Results: In total 426 patients were included. BKP was the most frequently chosen treatment
option (49%), followed by VP (34%) and NSM (14%). When compared with the panel
recommendations, inappropriate treatment choices were rare (5% for NSM, 2% for VP, none
for BKP). Treatment choice was strongly associated with the clinical variables used in the panel
study.
Differences in treatment decisions between interventional radiologists and surgeons were
largely determined by differences in patient characteristics, with time of clinical presentation
being the dominant factor.
Limitation: The study population was restricted to the practices of the participants of the
panel study.
Conclusion: This international, multi-specialty utilization review showed excellent applicability
of, and good adherence with RAND/UCLA-based recommendations on treatment choice in
OVCF.
Key words: Appropriateness criteria, utilization review, RAND/UCLA Appropriateness
Method, balloon kyphoplasty, non-surgical management, osteoporosis, vertebral compression
fractures, vertebroplasty
Criteria for the Appropriate Treatment of
Osteoporotic Vertebral Compression Fractures
