Spinal Fusions Ineffective for Vertebral Fracture Pain

Vertebral augmentation procedures such as vertebroplasty and balloon kyphoplasty do not promote pain relief following vertebral fracture (VF), claims a new study.

Researchers at Monash University (Melbourne, Australia), Beth Israel Deaconess Medical Center (Boston, MA, USA), the University of Sheffield (United Kingdom), and other institutions conducted a systematic literature review and meta‐analysis of studies in order to address what is currently known (and not known) on the safety and efficacy of vertebral augmentation, including reviewing available evidence to assess if VF risk is increased following the procedure.

The review found that vertebroplasty did not provide significantly better pain control than placebo in five randomized placebo-controlled trials, but there was weak evidence of the benefit of kyphoplasty in one clinical trial when compared to nonsurgical management. Potential harms from vertebroplasty and balloon kyphoplasty, on the other hand, included cement leakage, adjacent fractures, and more serious adverse events. The evidence was unclear if these procedures increased the risk of VF or related serious adverse events.

The review also found no evidence that spinal bracing reduced pain immediately after VF, although low-quality evidence suggested that wearing a brace for two hours a day over six months might help. Neither was there was evidence that exercise may improve mobility, alleviate pain, and reduce fear of falling. The researchers did mention the critical importance of anti-osteoporotic medications, which can reduce the risk of subsequent vertebral fractures by 40-70%. The study was published on January 24, 2019, in the Journal of Bone and Mineral Research.

“The message for doctors and their patients suffering from painful spinal fractures is that procedures to stabilize spinal fractures should not be a first choice for treatment. We found no significant benefit over the long-term in improving pain, back-related disability, and quality of life when compared with those who did not have the procedures,” concluded lead author Peter Ebeling, MBBS, of Monash University, and colleagues. “This is a painful condition that for most people spontaneously gets better with time, and can be managed with analgesic medications over the short-term.”

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. Surgical options include vertebroplasty, in which polymethylmethacrylate is injected into the fractured vertebral body; and balloon kyphoplasty, which uses a two-step process of inserting of a balloon device into the compacted vertebrae to attempt to restore it to a more normal shape before cement injection.

Related Links:
Monash University
Beth Israel Deaconess Medical Center
University of Sheffield