ACR Appropriateness Criteria Management of Vertebral Compression Fractures

Journal of the American College of Radiology

Charles T. McConnell Jr., MD

,

Franz J. Wippold II, MD  Charles E. Ray Jr, MD, PhD Barbara N. Weissman, MD

,

Peter D. Angevine, MD

,

Ian Blair Fries, MD

,

Langston T. Holly, MD

,

Baljendra S. Kapoor, MB, BS

,

Jonathan M. Lorenz, MD

,

Jonathan S. Luchs, MD

,

John E. O’Toole, MDNandini D. Patel, MDChristopher J. Roth, MDDavid A. Rubin, MD

Published Online: June 14, 2014

Publication stage: In Press Corrected Proof

This is an updated review of management of vertebral compression fracture for both benign osteoporotic and malignant causes. Vertebral compression fracture radiologic imaging evaluation is discussed. A literature review is provided of current indications for vertebral augmentation with percutaneous vertebroplasty and kyphoplasty as well as medical management. 
Limitations and potential benefits of these procedures are discussed. Variant tables describing various clinical situations are also provided to assist in determining appropriate use of these treatments for patient care.
The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. 
The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to formulate recommendations for imaging or treatment.

Key Words:

Appropriateness criteria, vertebral compression fracture, vertebroplasty, kyphoplasty, osteoporosis, management, treatment, MR