Vertebroplasty: A miracle for painful vertebral osteoporotic fractures or a clinical illusion…….. Author – Dr Sushant Ghate MS [Orth],
Assistant professor, Cooper Hospital, Mumbai
Preview: Vertebral insufficiency fractures are most common type of fractures occurring in patients with osteoporosis [1]. Nearly two third are asymptomatic and rest one third presents with acute back pain [2]. Usually such patient present with acute back pain and radiographs showing evidence of osteoporotic fracture and are generally considered for vertebral augmentation procedure either vertebroplasty or kyphoplasty on failure of conservative management. But two recent randomized controlled trials performed by Kallmes Et al and Buchbinder Et al has introduced doubts in mind of treating physicians regarding these procedures for relief of pain in vertebral insufficiency fractures [3, 4]. These papers subsequently sparked a lot of controversy and many authors have pointed out limitations and deficiency in designs of these studies. This is a very important factor to analyse, which should be considered before these studies alter our treatment strategy.
Review of literature: Buchbinder et al (2009) performed a multicenter double blind randomized trial in participants having osteoporotic vertebral fractures less than 12 months duration and unhealed as confirmed by MRI, randomly allotting them to undergo vertebroplasty or sham procedure. 35 underwent vertebroplasty and 36 were in placebo group [4]. At 3 months mean reductions in score for pain in vertebroplasty and control group were 2.6+/-2.9 and 1.9+/-3.3 respectively. They concluded that there was no beneficial effect of vertebroplasty in patients having painful osteoporotic vertebral fractures as compared to sham group at 1week, 1 month, 3 month or 6 month after treatment [4]. Kallmes et al (2009) conducted a multicenter trial randomly assigning 131 patients who had one to three painful osteoporotic fractures to undergo vertebroplasty or a simulated procedure without cement (control group) [3].
