Kyphoplasty Versus Vertebroplasty: An Analysis of Medicare Procedure Volumes, Payment, and Specialties From 2015 to 2023

Study Design: Retrospective cohort study. Objective: This study aimed to determine how kyphoplasty and vertebroplasty procedure volumes, specialty-specific usage, and payments have changed among the Medicare patient population from 2015 to 2023. Summary of Background Data: Vertebral augmentation procedures, specifically kyphoplasty and vertebroplasty, are used to treat vertebral compression fractures. Published studies have found kyphoplasties to be associated with lower rates of cement leakage and more favorable postoperative vertebral alignment, including improved local kyphotic angle. Methods: We used an aggregated data set that contains Medicare Part B procedure data at the physician level from 2015 to 2023 (n=1819 unique physicians total). We filtered for kyphoplasty and vertebroplasty Current Procedural Terminology codes, and then analyzed overall trends in procedure volume, payment, and specialty usage over time. We used statistical tests to identify differences in these parameters between kyphoplasty and vertebroplasty. Results: From 2015 to 2023, the total number of both kyphoplasty and vertebroplasty procedures decreased with a compound annual growth rate (CAGR) of −5.4% and −16.8%, respectively. In 2019, 2020, 2022, and 2023, there were more kyphoplasty procedures than vertebroplasty procedures ( P <0.05). 76.0% of all kyphoplasties were performed by orthopedic surgery, diagnostic radiology, and neurosurgery, whereas 87.3% of vertebroplasties were performed by diagnostic radiology and interventional radiology. From 2015 to 2023, kyphoplasties received higher payment amounts than vertebroplasties ( P <0.0001). The average payment amount for kyphoplasties slightly increased overall from 2015 to 2023, with a CAGR of 6.9%. Although previous studies have identified similar trends up until 2018, our study provides an updated understanding. Conclusions: Our analysis of a comprehensive Medicare data set found that kyphoplasties are more common than vertebroplasties, and the use of both procedures has decreased slightly over time. Diagnostic and interventional radiology both perform a large proportion of these procedures. Level of Evidence: Level IV.