Application Detail

Description of Medical Service

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.

Description of Medical Condition

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.

Reason for Application

New MBS item

Medical Service Type

Therapeutic medical service

Previous Application Number

27.1

Associated Documentation

Application Form

Application form (PDF 383 KB)
Application form (Word 118 KB)

Flow chart question 26 (PDF 340 KB)
Flow chart question 26 (Word 42 KB)

Flow chart question 40 (PDF 103 KB)
Flow chart question 40 (Word 46 KB)

IRSA Vertebroplasty MSAC letter (PDF 515 KB)
IRSA Vertebroplasty MSAC letter (Word 803 KB)

Consultation Feedback

Consultation Feedback Form (Word 506 KB)

PICO Confirmation

PICO Confirmation (PDF 292 KB)
PICO Confirmation (Word 695 KB)

Assessment Report

-

Public Summary Document

Public Summary Document - March 2019 (PDF 1137 KB)
Public Summary Document - March 2019 (Word 141 KB)

Public Summary Document - April 2020 (PDF 527 KB)
Public Summary Document - April 2020 (Word 101 KB)

Meetings for this Application

PASC

12 April 2017

ESC

4-5 October 2018
13-14 February 2020

MSAC

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 below.

Final Stakeholder Meeting Minutes (PDF 336 KB)
Final Stakeholder Meeting Minutes (Word 57 KB)