Vertebroplasty for Pain of Compression Fractures Over-rated

vertebroplasty
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Compression fractures are painful. It is estimated that 750,000 people in the United States suffer from these fractures each year. Current treatment has included medical therapy (bracing, analgesics, and physical therapy) and increasingly the surgical procedure vertebroplasty.

The findings of two new studies published this week in the New England Journal of Medicine suggest that use of vertebroplasty for treatment of pain of compression fractures is over-rated. Both studies found that there was no more improvement of the back pain relief when patients had vertebroplasty than when the patient had “sham” surgery.

Vertebroplasty involves injecting an orthopedic cement into the fractured vertebra using x-ray guidance. The procedure is often performed under local anesthetic with the patient going home the same day. The purpose is to stabilize the fracture, thereby reducing back pain and disability from the compression fracture.

Both studies enrolled patients who were randomly assigned to receive either vertebroplasty with cement or a “sham” vertebroplasty without cement. The Australia study had 78 participants. The Mayo Clinic study had 131 participants. The patients had from one to three vertebral compression fractures.

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In both studies, the patients in both groups noted a significant reduction in overall back pain, but there was no statistical difference in the amount of back pain relief gained.

Therefore, it would appear that back pain relief from vertebroplasty surgery for compression fractures may be over-rated. It is important to work with your doctor and decide the best treatment for you. Discuss the medical (bracing, analgesic, and physical therapy) and the surgical vertebroplasty.

Sources
A Randomized Trial of Vertebroplasty for Painful Osteoporotic Vertebral Fractures; New England Journal of Medicine, Volume 361 (6):557-568, August 6, 2009; Rachelle Buchbinder, Ph.D., Richard H. Osborne, Ph.D., Peter R. Ebeling, M.D., John D. Wark, Ph.D., Peter Mitchell, M.Med., Chris Wriedt, M.B., B.S., Stephen Graves, D. Phil., Margaret P. Staples, Ph.D., and Bridie Murphy, B.Sc.

A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures; New England Journal of Medicine, Volume 361 (6):569-579, August 6, 2009; David F. Kallmes, M.D., Bryan A. Comstock, M.S., Patrick J. Heagerty, Ph.D., Judith A. Turner, Ph.D., David J. Wilson, F.R.C.R., Terry H. Diamond, F.R.A.C.P., Richard Edwards, F.R.C.R., Leigh A. Gray, M.S., Lydia Stout, B.S., Sara Owen, M.Sc., William Hollingworth, Ph.D., Basavaraj Ghdoke, M.D., Deborah J. Annesley-Williams, F.R.C.R., Stuart H. Ralston, F.R.C.P., and Jeffrey G. Jarvik, M.D., M.P.H.

Radiological Society of North America (info on vertebroplasty)

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