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Vertebroplasty challenged in RCT

Thursday May 10th, 2018

Percutaneous vertebroplasty to repair spinal fractures does not lead to greater pain relief than a sham procedure, according to the findings of a new randomised trial.

The study was carried out on patients with acute osteoporotic vertebral compression fractures.

Dr Cristina Firanescu and colleagues at the Elisabeth TweeSteden Hospital in the Netherlands, carried out a randomised trial based at four community hospitals in the Netherlands. A total of 180 patients over 50 years of age took part, and were given either vertebroplasty or a sham procedure.

Average reduction in pain was statistically significant in both groups in the year after the procedure. Quality of life and use of painkillers were also similar in both groups, with both groups decreasing significantly in analgesia use. There were two adverse events relating to vertebroplasty.

In BMJ today (10 May) the authors conclude: "Percutaneous vertebroplasty did not result in statistically significantly greater pain relief than a sham procedure during 12 months' follow-up among patients with acute osteoporotic vertebral compression fractures."

In an editorial, Evan Davies, consultant spinal surgeon at Southampton General Hospital, UK, writes that these results "do not support using percutaneous vertebroplasty as standard pain treatment in these patients ,” adding that vertebroplasty before nine weeks "should probably be considered only in exceptional circumstances for patients with vertebral osteoporotic fractures.”

"Periosteal infiltration alone in the early phase provides enough pain relief with no need for additional cementation," the experts agree.

Firanescu, C. E. et al. Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV): randomised sham controlled clinical trial. BMJ 10 May 2018; doi: 10.1136/bmj.k1551

http://www.bmj.com/content/361/bmj.k1551

Tags: Europe | Rheumatology

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