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New Guideline Recommends Against Vertebroplasty

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New clinical guidelines released by the American Academy of Orthopaedic Surgeons recommend against a procedure known as a vertebroplasty. This procedure is relatively common, and is usually done when an osteoporotic patient suffers a compression fracture of the vertebra.

The new recommendation does not mean that there is harm in having had vertebroplasty, or that you need to do anything about it if you have had one. It just means that more studies have been done and as knowledge and research evolve, procedures that once seemed necessary or helpful sometimes are found to be unwarranted.

Dr. Stephen I. Esses was the chair of the group that reviewed the studies and statistics related to vertebroplasty over several years. He stated, "When you look at the science and research to-date, there is very strong Level 1 evidence to suggest that vertebroplasty does not provide the types of benefits that it was previously thought to provide.” Level one evidence includes clinical trials with blind randomization, and is done under strict guidelines.

Esses went on to say, “But there is not a worry that something is going to happen to you if you had this surgery already. There are no reported negative eventual side effects.”

Osteoporosis is fairly common, particularly in older women. When the bones become weaker, sometimes vertebrae can collapse. That is a compression fracture of the vertebra. The vertebra then becomes kind of smashed and sometimes wedge shaped, and this can throw the spine out of alignment and cause pressure on nerves in the area, resulting in pain, dysfunction, and sometimes deformity such as "dowager’s hump" or kyphosis.

Symptoms of vertebral fracture include pain near the fracture site that worsens with sitting or standing and may be relieved by rest or lying down. The New England Journal of Medicine puts the number of new vertebral fractures in the U.S. per year at 750,000.

Treatments other than surgery may include pain medication, physical therapy, and nerve blocks. Prevention of osteoporosis is important and ideally starts when you are young.

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EmpowHER Guest

The AAOS has only included studies published before Dec 2009 - which is curious given the publication of VERTOS11 earlier this year. The VERTOS11 study is clearly the largest RCT of vertebroplasty yet published. It studied acute fractures less than 6 weeks old and found vertebroplasty effective on several fronts. Vertebroplasty provided significant pain reduction at every time point out to 12 months. It also prevented ongoing fracturing and height loss in the vertebral body.
The placebo armed trials which the AAOS relies so heavily upon, studied healed fractures up to 12 months old. Despite the statistical algorithm a trial can be no more than what it samples. The current evidence shows that vertebroplasty is not effective for chronic, healed fractures but is very effective for acute fractures. I should have thought this would be self-evident to orthopaedic surgeons. I presume that the AAOS does not recommend other fracture fixation techniques (eg plaster cast) to palliate acute fracture pain to fractures that are 6 months old.
The position of the AAOS is 10 months out of date and scientifically meaningless.

October 11, 2010 - 5:04am
(reply to Anonymous)

Thank you for your comments. I have had patients who had significant relief after vertebroplasty myself. Those were also acute osteoporotic compression fractures.

However, these guidelines are news. Thanks for reading.

October 11, 2010 - 6:18am
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