Document Detail


Have recent vertebroplasty trials changed the indications for vertebroplasty?
MedLine Citation:
PMID:  20523998     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 <or=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.
Authors:
Afshin Gangi; William A Clark
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-06-04
Journal Detail:
Title:  Cardiovascular and interventional radiology     Volume:  33     ISSN:  1432-086X     ISO Abbreviation:  Cardiovasc Intervent Radiol     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-23     Completed Date:  2010-11-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003538     Medline TA:  Cardiovasc Intervent Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  677-80     Citation Subset:  IM    
Affiliation:
Department of Nonvascular Interventional Radiology, University Hospital of Strasbourg, 67091 Strasbourg, France. gangi@rad6.u-strasbg.fr
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MeSH Terms
Descriptor/Qualifier:
Back Pain / etiology,  surgery
Fractures, Compression / complications,  surgery*
Humans
Randomized Controlled Trials as Topic
Spinal Fractures / complications,  surgery*
Vertebroplasty / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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