Why we should stop performing vertebroplasties for osteoporotic spinal fractures

Abstract

While vertebroplasty enjoys continued use in some settings, there is now high‐moderate quality evidence based on systematic review that includes five placebo‐controlled trials that it provides no benefits over placebo and these results do not differ according to pain duration (≤6 vs >6 weeks). A clinically important increased risk of incident symptomatic vertebral fractures or other serious adverse events cannot be excluded due to small event numbers. Serious harms including cord compression, ventricular perforation, pulmonary embolism, infection and death have been reported. This unfavourable risk–benefit ratio should be convincing doctors and patients to stop the use of vertebroplasty. At the very least, clinicians should fully inform their patients about the evidence including the likelihood of improving without vertebroplasty and the potential harms, so that patients can make evidence‐informed decisions about their treatment. They should also warn patients about the pitfalls of relying on information sourced from the internet or from ‘awareness raising’ campaigns.

Efficacy of Recombinant Human Parathyroid Hormone versus Vertebral Augmentation Procedure on Patients with Acute Osteoporotic Vertebral Compression Fracture

“…VAP can significantly and quickly reduce back pain by restoring the stability of the fractured vertebra. Recently, however, high‐ to moderate‐quality evidence indicated that VAP offered no clinical benefits compared with the sham procedure and did not recommend VAP to treat acute or subacute OVCF 16 , 17 .…”

“…Vertebral augmentation procedure (VAP) was widely applied to stabilize the fractured vertebrae to relieve back pain immediately, considering the drawbacks of conservative treatment 15 . However, recent high‐ to moderate‐quality evidence indicates that VAP does not offer significant clinical benefits compared with the sham procedure 16 , 17 . One challenge was that VAP treatment only targeted the restoration of stability of the fractured vertebrae and did not improve vertebral bone mineral density (BMD) to decrease the fracture risk of the treated or non‐treated vertebrae 18 .…”

Vertebral Collapse Prevented Following Teriparatide Treatment in Postmenopausal Kümmell's Disease Patients with Severe Osteoporosis

“…VAP seems to be a promising method to maintain the vertebral height to prevent progressive vertebral collapse. However, controversies on its benefits for KD remain for lacking high‐ to moderate‐quality randomized controlled trials (RCTs) 14, 15, 27–29 .…”

Vertebroplasty has an important role in managing patients with severe pain when performed early and with appropriate technique

“…We thank Clark and co-authors for their ongoing interest in our work. 1 Their comments, 2 and published criticisms of our Cochrane review as outlined in our response, 3 are, however, without merit. We did not use 'spurious methods', 'statistical heterogeneity assessment to justify combining VAPOUR in meta-analyses', 'breach Cochrane protocol' or 'inaccurately cite trial data'.…”