Kyphoplasty and vertebroplasty: how good is the evidence?

The absence of Level I evidence undermines the credibility of all clinical studies pertaining to percutaneous vertebral augmentation (ie, kyphoplasty and vertebroplasty). The powerful desire to relieve suffering in the frail elderly cannot substitute for a rigorously designed randomized controlled trial comparing vertebral augmentation with continued nonoperative care. Though the level of available evidence is currently inadequate, its quality is improving.