1466 – Vertebroplasty for severely painful osteoporotic vertebral fractures of less than 6 weeks duration

New MBS item.

The procedure is performed in an Interventional Radiology suite using local anaesthesia. High quality fluoroscopic imaging is required. A needle is passed through the skin of the back and into the fractured vertebral body. The trabecular space of the vertebral body is progressively filled with polymethyl methacrylate (PMMA) using fluoroscopic imaging to guide the injection. The procedure is terminated when the vertebral body has an adequate distribution of PMMA to stabilise the fractured vertebral body (distribution from superior to inferior endplate and anterior cortex to posterior third of vertebral body in lateral projection and from pedicle to pedicle in frontal projection), or if PMMA begins to extravasate outside of the bone. The patient can be mobilised after 2 hours and outpatients can be discharged home at this time.

Type: Therapeutic medical service

Osteoporotic vertebral fractures are increasingly prevalent as the population ages. Most osteoporotic vertebral fractures cause mild or moderate symptoms and do not require intervention. A small but significant subset of patients experience severe pain and loss of function following the fracture. This can cause loss of independence and hospitalisation. Vertebroplasty can be used to provide pain relief when the pain is severe and poorly controlled by medication, and when the fracture is less than 6 weeks in duration. The alternative, larger dose of opiate analgesics causes many side effects in this patient group including delirium, nausea, constipation and increased propensity to falls. This patient group includes both outpatients and inpatients.

• PASC meeting: 12 April 2017
• ESC meeting: 
  • 4-5 October 2018
  • 13-14 February 2020
• MSAC meeting: 
  • 22-23 November 2018
  • 28-29 March 2019
  • 3 April 2020

Stakeholder Meeting Friday 7 June 2019

Members of MSAC, clinicians with experience and expertise in geriatric medicine, interventional radiology and spinal surgery; representatives of the applicant; representatives from consumer organisations; and representatives from the Department of Health met to discuss vertebroplasty. This was not an MSAC decision forum, but a meeting that would inform the issues considered by MSAC, following its March 2019 consideration of application 1466. The final minutes of this meeting are above.