Letter to the Editor: Is There Really No Benefit of Vertebroplasty for Osteoporotic Vertebral Fractures? A Meta-analysis
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To the Editor
We read with interest the article by Shi et al.  published in your journal that addresses the controversial topic of percutaneous vertebroplasty (PVP) using meta-analysis of selected literature. The authors’ conclusion  appears to contradict Recommendation 8 of the American Academy of Orthopaedic Surgeons (AAOS) “Clinical Practice Guideline (CPG) on the Treatment of Symptomatic Osteoporotic Spinal Compression Fractures” . We would like to address the differences between their analysis and that done by the AAOS CPG Workgroup.
Although the meta-analysis process was similar in both reviews, some methodologic aspects differ. AAOS established a priori content based inclusion and exclusion criteria for study selection . It is unclear how Shi et al. determined which articles to include. The AAOS Workgroup excluded three studies that they included [1, 4, 8] for poor study design description and for not being the best available evidence. A study is not the best available
- Alvarez L, Alcaraz M, Perez-Higueras A, Granizo JJ, de Miguel I, Rossi RE, Quinones D. Percutaneous vertebroplasty: functional improvement in patients with osteoporotic compression fractures. Spine (Phila Pa 1976). 2006;31:1113–1118.
- American Academy of Orthopaedic Surgeons: Clinical Practice Guideline on the Treatment of Symptomatic Osteoporotic Spinal Compression Fractures. Rosemont, IL, American Academy of Orthopaedic Surgeons, September 2010. Available at: http://www.aaos.org/research/guidelines/SCFguideline.asp. Accessed September 7, 2012.
- Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361:557–568. CrossRef
- Diamond TH, Champion B, Clark WA. Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med. 2003;114:257–265. CrossRef
- Farrokhi MR, Alibai E, Maghami Z. Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression fractures. J Neurosurg Spine. 2011;14:561–569.
- Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361:569–579. CrossRef
- Klazen CA, Lohle PN, de Vries J, Jansen FH, Tielbeek AV, Blonk MC, Venmans A, van Rooij WJ, Schoemaker MC, Juttmann JR, Lo TH, Verhaar HJ, van der Graaf Y, van Everdingen KJ, Muller AF, Elgersma OE, Halkema DR, Fransen H, Janssens X, Buskens E, Mali WP. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010;376:1085–1092. CrossRef
- Rousing R, Andersen MO, Jespersen SM, Thomsen K, Lauritsen J. 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). 2009;34:1349–1354.
- Shi MM, Cai XZ, Lin T, Wang W, Yan SG. Is there really no benefit of vertbroplasty for osteoporotic vertebral fractures? A meta-analysis. Clin Orthop Relat Res. 2012 June 23. [Epub ahead of print]
- Voormolen MH, van Rooij WJ, Sluzewski M, van der Graaf Y, Lampmann LE, Lohle PN, Juttmann JR. Pain response in the first trimester after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures with or without bone marrow edema. AJNR Am J Neuroradiol. 2006;27:1579–1585.
- Wang HK, Lu K, Liang CL, Weng HC, Wang KW, Tsai YD, Hsieh CH, Liliang PC. Comparing clinical outcomes following percutaneous vertebroplasty with conservative therapy for acute osteoporotic vertebral compression fractures. Pain Med. 2010;11:1659–1665. CrossRef
- Letter to the Editor: Is There Really No Benefit of Vertebroplasty for Osteoporotic Vertebral Fractures? A Meta-analysis
Clinical Orthopaedics and Related Research®
Volume 471, Issue 2 , pp 686-687
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