AN EVIDENCE-BASED APPROACH TO MANAGING VERTEBRAL COMPRESSION FRACTURES
Using the RAND™/UCLA Appropriateness Method (RAM), a multispecialty expert panel established a comprehensive clinical care pathway for VCF management.
This framework is intended to guide clinicians in making informed and reasoned VCF management decisions. The pathway may be used in many healthcare settings and may be helpful to reduce undesirable practice variations and improve quality of care.1
The VCF clinical care pathway includes guidance on:
- Key VCF signs and symptoms
- Diagnostic evaluation of VCF patients
- Appropriateness criteria for vertebral augmentation (VA) or nonsurgical management (NSM)
- Contraindications for VA
- Patient follow-up
THE BENEFITS OF PERSONALIZED CARE
Watch Dr. Joshua Hirsch and Elizabeth Thompson of the National Osteoporosis Foundation discuss the benefits of personalized care using the VCF care pathway.
PANEL METHODOLOGY
RAM provides a highly structured approach to produce patient-specific recommendations by combining best available scientific evidence with the collective judgment of a panel of experts.
- Literature review: The final document included the results of 83 studies (systematic reviews, randomized controlled trials, and observational studies), each including at least 200 patients.
- Panel process: Twelve-member expert panel chosen by steering committee based on scientific and clinical expertise in diagnosing and treating patients with VCF (neurosurgery, interventional neuro radiology, pain medicine, orthopedic surgery).
ASSUMPTIONS
Included:
- Patient presented to ER or outpatient clinic
- Moderate-to-severe back pain (VAS ≥ 5) as the primary or secondary complaint
Excluded:
- High-velocity trauma
- Suspected malignant non-fragility fracture
- Younger than 18 years
This project was supported by a grant from Medtronic. However, Medtronic was not involved in the design or execution of the project, nor the preparation and review of this manuscript. Names of panel members were not disclosed to the sponsor, and panel members were not informed about the identity of the sponsor before submission of the manuscript.
Limitation: Double-blinded doesn’t mitigate that the panel process was subjective input. It included strict adherence by the multidisciplinary experts to adopt the RAND methodology process, based on published clinical evidence and expertise.
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CLINICAL OUTCOMES
Explore additional clinical data for vertebroplasty and balloon kyphoplasty procedures.
EXPLORE CLINICAL DATA
1
Hirsch JA, Beall DP, Chambers MR et al. Management of vertebral fragility fractures: a clinical care pathway developed by a multispecialty panel using the RAND/UCLA Appropriateness Method. Spine J. 2018 Nov;18(11):2152-2161. doi: 10.1016/j.spinee.2018.07.025.