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Vertebroplasty
the Rise and Fall of a Convenient Truth

Vertebroplasty has become a favourite amongst doctors for the treatment of osteoporotic vertebral compression fractures. But not all of them and whilst research for the past decade only encourages the use of vertebroplasty, recently, more high quality studies refute its value.

Many articles and much discussion have appeared in the medical literature over the past 15 years but especially in the last two years after randomized sham controlled clinical trials challenged the common belief.

The "Vertebroplasty Affair" provides an opportunity to be reminded of science in medicine. The original story or hypothesis must stand up to highest levels of medical science research before it can be adopted as standard medical practice. For more than 10 years Vertebroplasty has expanded across the US and the rates for vertebropalsty doubled between 2001 and 2006.

Unfortunately, many in the medical profession have invested heavily, professionally, emotionally and financially in the 'story' of vertberoplasty.

Below, I have a brief 6.5 minute flash presentation to watch on the web or you can download the longer more detailed full screen 26 minute version here Vertebroplasty (28.8MB).

 

Vertebroplasty Transcript

References:

1. Aebi, M. (2009). "Vertebroplasty: about sense and nonsense of uncontrolled "controlled randomized prospective trials"." Eur Spine J 18(9): 1247-8.

2. Akl, E. A., M. Briel, et al. (2009). "LOST to follow-up Information in Trials (LOST-IT): a protocol on the potential impact." Trials 10: 40.

3. Al-Ali, F., T. Barrow, et al. (2009). "Vertebroplasty: what is important and what is not." AJNR Am J Neuroradiol 30(10): 1835-9.

4. Alvarez, L., M. Alcaraz, et al. (2006). "Percutaneous vertebroplasty: functional improvement in patients with osteoporotic compression fractures." Spine (Phila Pa 1976) 31(10): 1113-8.

5. Bono, C. M. (2006). "Point of view: the honest truth about vertebroplasty." Spine (Phila Pa 1976) 31(10): 1119.

6. Boszczyk, B. (2010). "Volume matters: a review of procedural details of two randomised controlled vertebroplasty trials of 2009." Eur Spine J 19(11): 1837-40.

7. Buchbinder, R., A. Barratt, et al. (2006). "Vertebroplasty." Aust Fam Physician 35(9): 665; author reply 665-6.

8. Buchbinder, R., D. Kallmes, et al. (2010). "Vertebroplasty versus conservative treatment for vertebral fractures." Lancet 376(9758): 2070-1; author reply 2071-2.

9. Buchbinder, R. and R. H. Osborne (2006). "Vertebroplasty: a promising but as yet unproven intervention for painful osteoporotic spinal fractures." Med J Aust 185(7): 351-2.

10. Buchbinder, R., R. H. Osborne, et al. (2009). "A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures." N Engl J Med 361(6): 557-68.

11. Buchbinder, R., R. H. Osborne, et al. (2009). "Vertebroplasty appears no better than placebo for painful osteoporotic spinal fractures, and has potential to cause harm." Med J Aust 191(9): 476-7.

12. Carragee, E. J. (2010). "The vertebroplasty affair: the mysterious case of the disappearing effect size." Spine J 10(3): 191-2.

13. Denaro, V., U. G. Longo, et al. (2010). "Vertebroplasty versus conservative treatment for vertebral fractures." Lancet 376(9758): 2071; author reply 2071-2.

14. Deramond, H., C. Depriester, et al. (1998). "Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results." Radiol Clin North Am 36(3): 533-46.

15. Diamond, T. H., B. Champion, et al. (2003). "Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy." Am J Med 114(4): 257-65.

16. Jarvik, J. G. and D. F. Kallmes (2009). "Point of view. Efficacy of vertebroplasty and kyphoplasty." Spine (Phila Pa 1976) 34(6): 613-4.

17. Jarvik, J. G., D. F. Kallmes, et al. (2003). "Vertebroplasty: learning more, but not enough." Spine (Phila Pa 1976) 28(14): 1487-9.

18. Jensen, M. E., A. J. Evans, et al. (1997). "Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects." AJNR Am J Neuroradiol 18(10): 1897-904.

19. Kallmes, D., R. Buchbinder, et al. (2009). "Response to "randomized vertebroplasty trials: bad news or sham news?"" AJNR Am J Neuroradiol 30(10): 1809-10.

20. Kallmes, D. F. (2008). "If one vertebroplasty is good, two must be better." Spine (Phila Pa 1976) 33(6): 579.

21. Kallmes, D. F., B. A. Comstock, et al. (2009). "A randomized trial of vertebroplasty for osteoporotic spinal fractures." N Engl J Med 361(6): 569-79.

22. Kallmes, D. F., J. G. Jarvik, et al. (2010). "Clinical utility of vertebroplasty: elevating the evidence." Radiology 255(3): 675-80.

23. Kallmes, D. F., P. A. Schweickert, et al. (2002). "Vertebroplasty in the mid- and upper thoracic spine." AJNR Am J Neuroradiol 23(7): 1117-20.

24. Kinkade, S. and J. J. Stevermer (2009). "Vertebroplasty for osteoporotic fracture? Think twice." J Fam Pract 58(12): 654-6.

25. Klazen, C. A., P. N. Lohle, et al. (2010). "Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial." Lancet 376(9746): 1085-92.

26. Kobayashi, N., Y. Numaguchi, et al. (2009). "Prophylactic vertebroplasty: cement injection into non-fractured vertebral bodies during percutaneous vertebroplasty." Acad Radiol 16(2): 136-43.

27. Lotz, J. C. (2009). "Trials of vertebroplasty for vertebral fractures." N Engl J Med 361(21): 2098; author reply 2099-100.

28. Martin, J. B., B. Jean, et al. (1999). "Vertebroplasty: clinical experience and follow-up results." Bone 25(2 Suppl): 11S-15S.

29. McKiernan, F., T. Faciszewski, et al. (2004). "Quality of life following vertebroplasty." J Bone Joint Surg Am 86-A(12): 2600-6.

30. McKiernan, F., T. Faciszewski, et al. (2005). "Does vertebral height restoration achieved at vertebroplasty matter?" J Vasc Interv Radiol 16(7): 973-9.

31. McKiernan, F. E. (2007). "Kyphoplasty and vertebroplasty: how good is the evidence?" Curr Rheumatol Rep 9(1): 57-65.

32. Rao, R. D. and M. D. Singrakhia (2003). "Painful osteoporotic vertebral fracture. Pathogenesis, evaluation, and roles of vertebroplasty and kyphoplasty in its management." J Bone Joint Surg Am 85-A(10): 2010-22.

33. Ross, P. D. (1997). "Clinical consequences of vertebral fractures." Am J Med 103(2A): 30S-42S; discussion 42S-43S.

34. Rousing, R., M. O. Andersen, et al. (2009). "Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures: three-months follow-up in a clinical randomized study." Spine (Phila Pa 1976) 34(13): 1349-54.

35. Suzuki, N., O. Ogikubo, et al. (2008). "The course of the acute vertebral body fragility fracture: its effect on pain, disability and quality of life during 12 months." Eur Spine J 17(10): 1380-90.

36. Suzuki, N., O. Ogikubo, et al. (2009). "The prognosis for pain, disability, activities of daily living and quality of life after an acute osteoporotic vertebral body fracture: its relation to fracture level, type of fracture and grade of fracture deformation." Eur Spine J 18(1): 77-88.

37. Trout, A. and D. Kallmes (2006). "Does vertebroplasty cause incident vertebral fractures? A review of available data." American journal of neuroradiology 27(7): 1397-403.

38. Voormolen, M. H., P. N. Lohle, et al. (2006). "Prospective clinical follow-up after percutaneous vertebroplasty in patients with painful osteoporotic vertebral compression fractures." J Vasc Interv Radiol 17(8): 1313-20.

39. Weinstein, J. N. (2009). "Balancing science and informed choice in decisions about vertebroplasty." N Engl J Med 361(6): 619-21.