A Comeback for Vertebroplasty?

Summary and Comment |
August 25, 2016

A Comeback for Vertebroplasty?

  1. Allan S. Brett, MD

The procedure benefitted some highly selected patients when performed a few weeks after vertebral fracture.

  1. Allan S. Brett, MD

Vertebroplasty is injection of polymethylmethacrylate “cement” into a fractured vertebral body to reduce pain and disability. The popularity of this procedure declined after 2009, when two randomized, sham-controlled trials showed no benefit (NEJM JW Gen Med Sep 1 2009 and N Engl J Med 2009; 361:569 and 557). However, patients in those two trials were enrolled an average of 9 and 18 weeks, respectively, after pain onset, which raises the following question: Would patients benefit if they were treated earlier?

To address this question, Australian investigators conducted another randomized trial that involved 120 patients (mean age, 80) with vertebral fractures (61% of vertebral fractures were in “thoracolumbar” segments [T11 through L2]), pain of 1 to 6 weeks' duration (mean, 18 days), and pain scores ≥7 on a 10-point scale. Patients received either vertebroplasty or a placebo procedure (subcutaneous infiltration with lidocaine, and activity in the procedure suite that mimicked vertebroplasty).

The primary outcome — pain score <4 at 14 days — occurred significantly more frequently in the vertebroplasty group than in the placebo group (44% vs. 21%). The difference remained significant at 6 months (69% vs. 47%). A functional disability score was significantly better with vertebroplasty than with placebo at 1, 3, and 6 months (but not earlier). In subgroup analyses, vertebroplasty was beneficial only when fracture age was <3 weeks and only for fractures at T11 through L2. Two vertebroplasty patients had serious procedural complications; two placebo patients had spinal cord compression due to fracture retropulsion during follow-up.

Comment

Vertebroplasty was superior to placebo when performed a few weeks after pain onset — but only for low-thoracic and high-lumbar fractures in patients with relatively severe pain; however, only one of every four treated patients benefitted in this study. The procedure should not be used too early (e.g., during the first week), as many patients have early improvement without vertebroplasty.

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (1)

Benjamin Schwartz Physician, Oncology

Think how many patients, who may have benefitted from this procedure have been denied this procedure by the government and their insurance company cronies based on a different study. Basing reimbursement on mercurial 'evidence based medicine' is a cynical and nihilistic attack on the individual patient and the doctor. A true patient's Bill of Rights would ban this tyrannical practice.

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.