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Percutaneous Vertebroplasty is no Risk Factor for New Vertebral Fractures and Protects Against Further Height Loss (VERTOS IV)

  • Clinical Investigation
  • Non-Vascular Interventions
  • Published:
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Abstract

Background

Percutaneous vertebroplasty (PV) is an alternative option to treat pain after an osteoporotic vertebral compression fracture (OVCF). Controversy exists as to whether PV increases the risk of new OVCFs or prevents further vertebral height loss in treated levels. We assessed both during 1-year follow-up in patients with acute OVCF randomised to PV or a sham procedure.

Methods

VERTOS IV is a prospective, multicentre, randomised controlled trial comparing PV with sham therapy in 180 patients. New OVCFs and further vertebral height loss were assessed at 3, 6, and 12 months.

Results

After a median follow-up of 12 months (interquartile range (IQR) = 12–12) 31 new fractures were reported in 15 patients from the PV group and 28 new fractures in 19 patients from the sham group. The occurrence of new vertebral fractures did not significantly differ between the groups (χ2(1) = 0.83, p = 0.36, OR = .71, 95%CI = 0.33–1.50). There was no higher fracture risk of adjacent versus distant vertebrae. After sham procedure, further height loss of treated vertebrae occurred more frequently (7 patients (8%) in the PV group and 39 (45%) in the sham group (χ2(1) = 28.85, p < 0.001, OR = 9.84, 95%CI = 4.08–23.73)) and was more severe (p < .001) than after PV.

Conclusions

The risk of further vertebral height loss is significantly lower after PV compared to a sham intervention, i.e. PV protects against progressive vertebral height loss. In addition, PV does not increase the risk of new adjacent and distant OVCFs.

Level of Evidence

Level 1a, therapeutic study.

ClinicalTrials.gov number, NCT01200277

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Availability of Data and Materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

This study was supported by Stryker (Grant No. S-I-013). The sponsor had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Author information

Author notes

  1. Cristina E. Firanescu, Alexander Venmans, and Paul N. M. Lohle have contributed equally to this work.

Authors and Affiliations

  1. Departments of Radiology and Internal Medicine, Elisabeth TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands

    Cristina E. Firanescu, Jolanda de Vries, Marinus C. Schoemaker, Albert J. Smeets, Esther Donga, Job R. Juttmann, Alexander Venmans & Paul N. M. Lohle

  2. Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands

    Jolanda de Vries & Paul Lodder

  3. Department of Radiology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands

    Caroline A. H. Klazen

  4. Department of Radiology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands

    Otto E. H. Elgersma

  5. Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands

    Frits H. Jansen, Irene van der Horst & Marion Blonk

Authors
  1. Cristina E. Firanescu
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  2. Jolanda de Vries
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  3. Paul Lodder
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  4. Marinus C. Schoemaker
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  6. Esther Donga
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  7. Job R. Juttmann
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  8. Caroline A. H. Klazen
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  9. Otto E. H. Elgersma
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  12. Marion Blonk
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  13. Alexander Venmans
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  14. Paul N. M. Lohle
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Contributions

CEF and PNML had full access to all the data in the study, take responsibility for the integrity of the data and the accuracy of the data analysis, and act as guarantors. PNML, CAHK, JdV, MCS, AJS, JRJ, ED, OEHE, and FHJ designed the study. IVDH, MB, and KS gathered the data. PNML, MCS, AJS, CAHK, OEHE, and FHJ performed the procedures. PL and JdV analysed the data. CEF and AV undertook morphometric measurements. CEF, PNML, AV, JdV, and PL wrote the first draft, and all the contributors made the decision to submit the manuscript for publication.

Corresponding author

Correspondence to Cristina E. Firanescu.

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Conflict of interests

The authors declare that they have no competing interest.

Ethics Approval and Consent to Participate

The procedures were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This trial was an institutional review board-approved sham-controlled, double-blind, multicentre, randomised trial performed at four community hospitals in the Netherlands (MN-11-004, approval protocol 1055).

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Firanescu, C.E., de Vries, J., Lodder, P. et al. Percutaneous Vertebroplasty is no Risk Factor for New Vertebral Fractures and Protects Against Further Height Loss (VERTOS IV). Cardiovasc Intervent Radiol 42, 991–1000 (2019). https://doi.org/10.1007/s00270-019-02205-w

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  • DOI: https://doi.org/10.1007/s00270-019-02205-w

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