Vertebroplasty and Kyphoplasty in the United States: Provider Distribution and Guidance Method, 2001-2010

OBJECTIVE. The purpose of this study was to determine the utilization by specialty and guidance method for vertebral augmentation (including vertebroplasty and kyphoplasty) in the United States from 2001 to 2010. MATERIALS AND METHODS. Using the 2001 through 2010 United States part B Medicare claims database, we studied the CPT-4 (Current Procedural Terminology, 4th ed.) codes used for thoracic (22520) and lumbar (22521) vertebroplasty, thoracic (22523) and lumbar (22524) kyphoplasty, and the method of radiologic guidance (76012 for fluoroscopy and 76013 for CT). For each of these codes, volume and physician specialty were tabulated. RESULTS. Radiologists performed 73% of Medicare-reimbursed vertebroplasty procedures in the United States in 2001-2010 and 30% of kyphoplasty procedures from 2006 to 2010. The majority were performed by nonradiologists, most notably orthopedic surgeons, who accounted for 40%. Although there was a decrease in utilization of vertebroplasty and kyphoplasty from 2009 to 2010, the number of vertebroplasties increased by 72.9% from 2001 to 2010, and the number of kyphoplasties increased by 12.0% from 2006 to 2010. Fluoroscopy is nearly universal as a guidance method for both vertebroplasty and kyphoplasty. CONCLUSION. This study shows that despite controversy regarding the long-term efficacy of vertebral augmentation, including vertebroplasty and kyphoplasty, utilization has risen since these procedures have been instituted and fluoroscopy is nearly universal as a guidance method. For vertebroplasty, the decrease in utilization from 2007 to 2009 may be explained in part by a combination of the initiation of kyphoplasty codes in 2006 and the August 2009 Kallmes et al. and Buchbinder et al. publications. Decreased utilization of both vertebroplasty and kyphoplasty from 2009 to 2010 may also be partly due to these publications.