What is the better treatment for osteoporotic vertebral compression fractures (VCF)? An analysis of data in the medical literature finds that vertebroplasty provides more pain relief and better function for patients than do the nonoperative treatments presently in use.
Intervention Superior to Conservative Care in VCF Fractures
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Vertebral compression fractures are the most common type of osteoporotic fractures. They can result in severe back pain, spinal deformity, muscle atrophy, physical decline, prolonged hospitalization, and, even, an increased risk of premature death. There has been conflicting evidence about whether percutaneous vertebroplasty (PVP) is beneficial for the treatment of vertebral compression fractures.
Ming-Min Shi and colleagues from Zhejiang University in the People’s Republic of China decided to investigate. Shi and his team analyzed 886 patients from nine previously published randomized trials. They sought to determine whether PVP better relieves pain, improves quality of life, and if it increases the recurrence of fractures compared to two control models. The control models were nonoperative treatment, which included bed rest, pain relief and bracing, and a “sham” therapy in which injections were given without the acrylic cement.
Compared with nonoperative therapy they found PVP was more effective at relieving pain and improving quality of life in patients with vertebral fractures. Pain relief and quality of life were comparable after PVP and sham injections, at various time points. PVP was not linked to a higher recurrence of fractures compared with the other two treatments.
The authors conclude: “Different control groups in individual studies to date may explain the varying conclusions about the ability of vertebroplasty to relieve pain and improve patients’ quality of life. Our analysis shows that, compared with other treatments, PVP relieves pain and improves quality of life without increasing the risk of new fractures.” Shi’s work is published online in Springer’s journal, Clinical Orthopaedics and Related Research, according to the July 10 news release.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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