Treatments for Vertebral Body Compression Fractures

CMS evidence review | evidence_type=MEDCAC Meeting | record_type=medcac_meeting | document_id=29 | meeting_date=2005-05-24

Back pain and related problems have substantial public health impact within the Medicare population each year, including discomfort, loss of mobility, and serious morbidity. CMS has identified this important issue for long-term examination. Disease conditions interest include disc degeneration, spinal stenosis, spondylolisthesis, and vertebral compression fractures. Vertebral body compression fractures of the spine are among the most common fracture types in patients who have osteoporosis. Compression fractures of the spine are also caused by osteolytic destruction, secondary to malignancy. Pain and loss of function are the most common symptoms. Percutaneous vertebroplasty is a minimally invasive treatment that inserts bone cement into the compressed and fractured vertebrae to provide mechanical stabilization. Kyphoplasty is a variation of vertebroplasty. Kyphoplasty uses an inflatable balloon to expand the compressed vertebral body, in an attempt to restore its natural height before injecting a cement-like substance into the vertebral cavity. As an initial step, CMS will review the scientific evidence on the effectiveness of surgical management of vertebral compression fractures, particularly vertebroplasty and kyphoplasty procedures, in the Medicare population. We will refer this issue to the Medicare Coverage Advisory Committee (MCAC). Committee members will be given presentations on the current literature and also receive public comments to aid in the discussions and recommendations regarding the quality of the evidence on verterbroplasty and kyphoplasty procedures. We expect to hold additional future meetings of the Medicare Coverage Advisory Committee regarding other back pain treatments and will post future notices in the Federal Register.