Vertebroplasty Found to be Useless for Osteoporotic Fracture and Disk Pain
Two articles in today’s New England Journal of Medicine are the first randomized placebo controlled trials of vertebroplasty, a procedure which involves injecting cement into the vertebrae of people who have suffered from painful osteoporotic fractures of the vertebrae. In the first study 78 patients got either vertebroplasty or a fake procedure. There was no difference in pain ratings measured at several time points out to six months.
The second study involved 131 patients who got either a sham or vertebroplasty procedure. There were no differences in the primary outcomes of pain or disability at one month after treatment. There was a pattern of clinical improvement in pain (30% reduction in pain, 64% v 48%, p=0.06) that was not one of the original study outcomes. The group that got the sham procedure, however, were more likely to request a repeat procedure (i.e. got a vertebroplasty in the end) (43% v 12%, p<.05). Some of the authors said they were “shocked” by the results and others said they should do “more research” or that it “might help some patients” or “maybe they want a placebo” since the fake group got better as well as the vertebroplasty group. Maybe they should pay the $4,000 for the MRI and procedure out of their pockets rather than billing it to Medicare so that they have a better placebo response. That would help out on President Barack Obama’s plans to reduce US healthcare costs by eliminating the 30% of tests and procedures that have been found to be useless. He can add this one to the list.
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By Dan, August 6, 2009 @ 9:47 am
Thanks for posting on this topic, Doug.
I suffered a vertebral compression fracture about 5 years ago, and this treatment was offered to me.
I refused, because from the research I did, there was no guarantee I would experience relief with such a procedure.
In fact, any back surgery only provides relief in about half of all patients, I believe.
By Therapy Patient, August 6, 2009 @ 11:33 am
I am not educated on these things, but wouldn’t an objective of such a procedure be to make the bone stronger, so that a better assessment might be to see what happens to the spine function over time. I wonder why pain was the criteria? To me the worse part of osteoporosis is the collapsing vertebrae that lead to permanent hunching over which happened to both my mom and both grandmothers. If THAT could be prevented it would be successful regardless of pain outcome.
By Doug Bremner, August 6, 2009 @ 3:33 pm
It does make the bone stronger but can make adjacent spinal vertebrae more unstable.
By Cement Lover, October 15, 2009 @ 1:44 pm
Looks like this post is famous and irresponsible.
http://www.spine.org/Documents/NASSComment_on_Vertebroplasty.pdf