Has Vertebroplasty Surgery Outlived its Value for Treatment of Osteoporosis?
For the last 25 years, vertebroplasty has been a surgical spinal procedure recommended to treat individuals with acute vertebral fractures commonly occurring with osteoporosis. The procedure requires using long needles that are inserted through the pedicles (tubes) on the sides of the vertebrae into the large central vertebral body. Once the needle is inserted into the space that has collapsed secondary to the fracture, cement is injected to stabilize the area. The thought being that with stabilization of the area, spinal pain will be decreased. A number of clinical studies published over the years have supported the benefit of vertebroplasy but well controlled comparative trials.1 The results of a recent clinical trial completed by doctors from the Netherlands suggest that vertebroplasty is no better than a sham procedure in helping the spinal pain associated with spinal fracture.2
About 180 participants requiring treatment for acute vertebral compression fractures resulting from osteoporosis were enrolled in a clinical trial directly comparing vertebroplasty (91) or a sham procedure (89). All participants had 1 to 3 acute vertebral fractures for up to 9 weeks in duration, had diminished bone mineral density, a 15% or more loss of vertebral height, and bone edema on magnetic resonance imaging. The procedures were the same in both groups except for the injection of the cement in the active therapy group.
Performance of the procedure was convincing with 82% of the vertebroplasty and 81% of the sham group believing they had undergone the cementing procedure. The main outcome measure evaluated by the researchers was the reduction in pain scores which were measured at one day, one week, and one, three, six, and 12 months following the procedure. Secondary outcomes were changes in quality of life and disability.
The reduction in pain score was similar in both groups and no significant differences were detected at any time between individuals undergoing vertebroplasy or the sham procedure. The only adverse events occurred in the cement group. Placing cement under increased pressure has the potential of causing additional fracture, some of which may expand into the spinal canal causing nerve damage. The results of this study demonstrate that the use of cement to support fractures is not better than a sham procedure.
What might be a better course of action is to treat the decreased bone mineral density (osteoporosis or osteopenia) that resulted in the fracture in the first place. You can learn more about the prevention and management of osteoporosis here.
David Borenstein, MD
Executive Editor TheSpineCommunity.com
Buchbinder R et al. Percutaneous veertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Systematic Review, 2015;(4):CD006349;doi:10.1002/14651858.CD006349.pub2
Firanescu CE et al. Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV): randomized sham controlled clinical trial. BMJ 2018 May 9,361:k1551.doi:10.1136/bmj.k1551