Aug. 9, 2010 -- Vertebroplasty -- a popular, minimally invasive treatment that uses injections of bone cement to seal up spinal vertebral fractures -- is safe, effective, and provides more back pain relief than conservative treatment in patients with acute vertebral fractures, according to new research published online in The Lancet.
"Pain relief after vertebroplasty is immediate, is sustained for at least a year, and is significantly greater than that achieved with conservative treatment at an acceptable cost," conclude the researchers who were led by Caroline A.H. Klazen, MD, a radiologist at St. Elisabeth Ziekenhuis in Tilburg, Netherlands.
Every year, 1.4 million people worldwide sustain vertebral compression fractures that cause pain and disability and affect their quality of life. Most of these fractures are due to osteoporosis, and having one fracture increases your risk of sustaining another. Enthusiasm for vertebroplasty was tempered when the findings of two widely publicized studies showed that it was no more effective than a dummy or sham procedure.
Individuals included in the new study had severe back pain for six weeks or less and a score of five or higher on a standardized measure of pain. The 101 people who underwent vertebroplasty had better and faster pain relief than their counterparts who received conservative care. This pain relief lasted for at least one year. People who had vertebroplasty also used fewer painkilling medications than those who received conservative care to treat their vertebral fractures, the study showed.
Conservative treatment was defined as bed rest, medications to alleviate pain, physical therapy, casting, and the use of medications to treat the brittle bone disease osteoporosis. Vertebroplasty is a minimally invasive procedure in which doctors inject medical-grade cement to stabilize collapsed vertebrae. Participants knew which treatment they were receiving due to the nature of the procedure.
Patient Selection Key to Success
The new study findings mirror what doctors such as Joseph Lane, MD, director of the Metabolic Bone Disease Service and director of the Osteoporosis Prevention Center at Hospital for Special Surgery in New York City, see in their practice.
Calling the study "very impressive," Lane tells WebMD that that "the significant pain relief and better function seen among people who had vertebroplasty are consistent with what clinicians who have been doing this procedure are seeing."
The older studies that showed no benefit of vertebroplasty over sham procedure had severe flaws in terms of the people who were included. Candidates for vertebroplasty need to have a high level of pain, he says. In the older studies, patients were not told what procedure they were given so they had to remain awake in a position that would not be possible for individuals in severe enough pain to benefit from vertebroplasty.
Treating Compression Fractures
In an accompanying editorial, Douglas Wardlaw, MD, of the Woodend Hospital in Aberdeen, Scotland, and Jan Van Meirhaeghe, MD, of Algemeen Ziekenhuis St. Jan in Bruge, Belgium, write that the new study "provides another chapter in the search for the optimum treatment of vertebral compression fractures [and] lends support to the large body of medical opinion that vertebroplasty has a part to play in the management of the pain of vertebral compression fractures."
Results of ongoing studies should help further explain the role that vertebroplasty has in treating vertebral compression fractures, they write. Four studies are under way that compare vertebroplasty to kyphoplasty, a procedure in which a balloon is inserted into the fractured vertebra and inflated from within the vertebra to restore its height and shape. When the balloon device is removed, a cavity remains and is filled with special bone-strengthening cement.