CardioVascular and Interventional Radiology

, Volume 33, Issue 4, pp 677–680

Have Recent Vertebroplasty Trials Changed the Indications for Vertebroplasty?

Review Article/State of the Art

DOI: 10.1007/s00270-010-9901-3

Cite this article as:
Gangi, A. & Clark, W.A. Cardiovasc Intervent Radiol (2010) 33: 677. doi:10.1007/s00270-010-9901-3

Abstract

Two different investigators in the New England Journal of Medicine recently published two randomized controlled trials (RCTs) regarding the efficacy of vertebroplasty for painful osteoporotic vertebral compression fractures. In their results, both investigators concluded that there was no significant difference in pain relief between the vertebroplasty group and control group 1 month after treatment. The trials described a different patient cohort from the one we treat with vertebroplasty. Both enrolled patients had back pain for ≤12 months. This duration of pain was far too long for a vertebroplasty trial, resulting in parallel trials of vertebroplasty on healed fractures. Where a study is needed, it should be comprised of patients with acute osteoporotic compression fractures, particularly those who are hospitalized or bedridden because of the pain of such fractures. Magnetic resonance imaging was not systematically performed before vertebroplasty, and inpatients were excluded. Inpatients with acute fracture pain are the group most likely to respond well to vertebroplasty. Enrolment was a problem in both trials. Randomization in both RCTs took >4 years for completion. We advise that vertebroplasty be offered to patients with recent fractures <8 weeks old who have uncontrolled pain as well as patients progressing to osteonecrosis and the intravertebral vacuum phenomenon (Kummels disease). The availability of recent MRI scanning is also critical to proper patient selection.

Keywords

VertebroplastyOsteoporosisVertebral compression fractureVertebroplasty trials

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010

Authors and Affiliations

  1. 1.Department of Nonvascular Interventional RadiologyUniversity Hospital of StrasbourgStrasbourgFrance
  2. 2.Department of Interventional RadiologySt George Private HospitalKogarahAustralia