David Forrest Kallmes MD, Presenter: Research support, ArthroCare Corporation Research support, Cardinal Health, Inc Research support, Micrus Corp Research support, MicroVention, Inc Research support, Chestnut Medical Technologies, Inc Research support, Sequent Medical, Inc Shareholder, Morris Innovative Research Consultant, Skeltex Inc

Spinal augmentation is considered standard of care for pain palliation in patients suffering from nonhealing, osteoporotic compression fractures. Multiple randomized trials have recently been reported. An unblinded trial (Fracture Reduction Evaluation, or FREE) comparing Kyphoplasty to medical therapy showed profound benefit of augmentation at all time points up to two years. Two independent, placebo controlled trials (INvestigational Vertebroplasty Efficacy and Safety Trial, or INVEST, and the Australian Vertebroplasty trial) compared vertebroplasty to a "control intervention" in which vertebroplasty was simulated but no cement infused. These latter trials showed no benefit, up to one month for INVEST and up to six months for the Australian trial, of augmentation over the control intervention. Further research is of critical importance to improve our understanding of augmentation in multiple areas, including but not limited to the impact of patient selection, the relative efficacy of various subtypes of augmentation, and the importance of patient expectation, or the placebo effect, on outcomes.

Kallmes, D, Musculoskeletal Keynote Speaker: Why We Should Stop Doing Vertebral Augmentation, Except in Clinical Trials.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8503035.html