Vertebral Augmentation and the Perils of Misdirection

Recent online commentaries have reignited a long-settled debate about vertebral augmentation (VA) for osteoporotic compression fractures—this time on social media rather than in scientific forums. In October 2025, Dr. Eugene Carragee claimed vertebroplasty “did not result in statistically greater pain relief than a sham procedure” and remains a “wasteful, harmful” practice (Lown Institute, 2025).

This is not simple misinformation—it is misdirection. Carragee’s argument leans on data that are not only obsolete but were never valid in the first place. The 2009 “sham” trials he cites (Buchbinder and Kallmes) have long been discredited for using active shams, enrolling patients with minimal pain, and allowing extensive crossover—design flaws that made statistical equivalence inevitable.

Modern Level I–II studies have since overturned those results. The 2018 International Journal of Spine Surgery meta-analysis I co-authored with Beall et al. reviewed 25 comparative trials across balloon kyphoplasty (BKP), vertebroplasty (VP), and implant-based augmentation (VAI). Both BKP and VP demonstrated clear, clinically meaningful pain and function gains versus nonsurgical management—directly refuting any claim of “placebo” benefit (Beall et al., 2018).

ISASS translated that evidence into its 2019 policy statement, concluding that “strong support exists for vertebral augmentation in symptomatic vertebral compression fractures” (Clerk-Lamalice et al., 2019). The public-health burden is immense: 1.5 million Americans sustain osteoporotic VCFs annually, costing $17 billion and carrying higher mortality than hip fractures. In a Medicare cohort exceeding one million patients, vertebral augmentation reduced mortality by 22–36 percent compared with nonsurgical care (Edidin et al., 2011).

Physicians must distinguish healthy skepticism from strategic misdirection. Rearranging facts to revive controversy misleads payers, confuses patients, and undermines evidence-based coverage. The record is clear: Level I–II evidence, meta-analytic synthesis, and policy consensus affirm vertebral augmentation as a safe, effective, and life-extending procedure. What persists is not new science but narrative spin. Our duty as spine surgeons is to ensure decisions—in clinics, boardrooms, and public discourse—rest on data, not distortion.