Vertebroplasty Ineffectual for Osteoporotic Compression Fractures

A new study suggests that spinal surgery for osteoporotic vertebral compression fractures does not offer significant pain relief.

Researchers at Elisabeth TweeSteden Hospital (ETZ; Tilburg, The Netherlands), Catharina Hospital (Eindhoven, The Netherlands), and other institutions conducted a randomized, double blind, sham controlled clinical trial to assess if percutaneous vertebroplasty results in more pain relief than a sham procedure. The study included 180 patients with acute osteoporotic compression fractures of the vertebral body, who were randomized to vertebroplasty (91 patients) or a sham procedure (89 patients). The vertebroplasty group also underwent cementation, which was simulated in the sham procedure group.

The main outcome measure was mean reduction in visual analogue scale (VAS) scores at one day, one week, and one, three, six, and 12 months. The results showed that mean reduction in VAS score was statistically significant in both vertebroplasty and sham procedure groups at all follow-up points after the procedure, except at 12 months’ follow-up. Use of analgesics--non-opioids, weak opioids, strong opioids--decreased statistically significantly in both groups at all time points, with no statistically significant differences between groups. The study was published on May 9, 2018, in BMJ.

“Participants in both study groups showed immediate improvement in pain and disability after the procedure, and this improvement was sustained during 12 months’ follow-up,” concluded lead author Cristina Firanescu, MD, of the departments of radiology and internal medicine. “These results suggest that factors aside from instillation of polymethylmethacrylate might have accounted for the observed clinical improvement after vertebroplasty; for example, the effect of local anesthesia, expectations of pain relief (placebo effect), natural healing of the fracture, and regression to the mean.”

Osteoporotic compression fractures of the vertebral body can result in pain and long-term morbidity, including spinal deformity. Conservative management includes opioids and other analgesics, bed rest, and a back brace. In percutaneous vertebroplasty, polymethylmethacrylate is injected into the fractured vertebral body; a technique that became widespread on the basis of preliminary observational and trial results and was endorsed by professional societies. But conflicting trials on the role of vertebroplasty in treating acute osteoporotic compression fractures of the vertebral body have raised debate.

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Elisabeth TweeSteden Hospital
Catharina Hospital