Johns Hopkins Health Alert
Should You Consider Vertebroplasty? Heres What the Research Suggests
If you've ever experienced the pain of an osteoporosis-induced vertebral compression fracture, you know how excruciating and incapacitating it can be. Fortunately, for some people with compression fractures, vertebroplasty has offered pain relief, especially when more conservative approaches like pain medication, bed rest and back braces fail to provide pain relief.
Today, more than 70,000 vertebroplasty procedures are performed each year. But two studies, published in The New England Journal of Medicine, reached the controversial conclusion that vertebroplasty may be of no more benefit than a placebo. The fallout from these studies has sparked an international debate over the efficacy of vertebroplasty.
What happens during vertebroplasty? During the vertebroplasty procedure, a medical-grade acrylic cement known as polymethylmethacrylate (PMMA) is injected through a small needle directly into the fractured vertebra. Vertebroplasty is performed on an outpatient basis, and the PMMA dries within minutes. Though vertebroplasty is not without its risks -- heart and lung damage from leakage of the PMMA and infections -- it's generally regarded as a safe operation. After 24 hours of bed rest, most people can return to normal, nonstrenuous activities.
What we learned from the two trials. In the first randomized, double-blind study, Australian researchers followed 71 people with painful, unhealed vertebral compression fractures who either underwent vertebroplasty or had a sham procedure that mimicked the operation in every way except for the injection of PMMA. One week, one month, three months and six months after the procedure, the participants reported their level of pain.
The participants who underwent vertebroplasty had a significant reduction in pain at all of these time points, but the degree of pain relief was no greater than that reported by those who had the sham procedure. Based on these findings, the researchers concluded that vertebroplasty had no beneficial effect.
The second study included 131 participants who again were divided into two groups who had either vertebroplasty or a sham procedure. One month later, a similar and significant amount of pain relief occurred in both groups, just like in the first study.
Bottom line advice on vertebroplasty. For now, based on the New England Journal of Medicine studies, the American Academy of Orthopaedic Surgeons has issued guidelines recommending against the use of vertebroplasty.
A range of additional treatments is available for back pain associated with vertebral compression fractures -- medication, back braces, kyphoplasty and spinal fusion -- and there is not yet a consensus that one treatment is superior to another. For now we recommend that you talk with your doctor about your particular back problem and weigh all the options before deciding which treatment is best for you.
Posted in Osteoporosis on March 1, 2012
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