Affiliation:
1. Johns Hopkins University, Baltimore, MD
Abstract
Background: Vertebral compression fractures are a common pathology affecting primarily
the elderly, postmenopausal women, and those with metastatic vertebral disease. Vertebral
augmentation procedures are popular treatment options for stability and pain relief. Preliminary
studies have suggested that such procedures are adequately efficacious. However, the first
randomized controlled trials (RCTs) published in the New England Journal of Medicine in 2009
showed that these procedures were not significantly different than placebo with regards to
pain relief and quality of life. These studies were met with considerable criticism. The matter
was further complicated when The Lancet published an RCT of its own that demonstrated
the superiority of vertebroplasty over conservative management. The conflicting evidence
has sparked ongoing debate in the medical community. All sides have provided arguments
supported by evidence of varying strength and validity.
Objective: To provide a concise and comprehensive presentation of the controversy
surrounding vertebral augmentation procedures and the evidence cited by proponents on
both sides of the debate.
Methods: We began by researching the major randomized controlled trials both for and
against vertebroplasty. These articles were already known to us, and were used as a starting
point. We then performed a literature search in PubMed for articles dated from 2000 through
2012. The bibliographies of major articles and reviews were also cross-referenced for additional
sources.
Results: A number of articles that included comprehensive and systematic reviews, metaanalyses, and commentaries about noted studies were found. These provided a broad, detailed
overview of the subject. Many of the common themes of these articles included limitations in
the design, methods, and patient selection with regard to the RCTs and other available studies.
Limitations: This review does not analyze the quality of evidence available nor does it
provide an opinion in this regard. The conclusions of the present article are, therefore, general
and descriptive in nature.
Conclusions: The arguments presented by proponents of both sides of the debate appear to
have validity. All of the major studies cited as evidence for or against vertebral augmentation
procedures have limitations in their quality. Consequently, the debate cannot be concluded,
convincingly, until more elaborate studies are conducted involving larger numbers of patients
with clear procedure methods agreed upon by the major authorities in the field.
Key words: Vertebroplasty, kyphoplasty, vertebral augmentation procedures, controversy of
vertebroplasty, vertebral cancer, vertebral pain, compression fractures, back pain, vertebral
fractures.
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine
Cited by
3 articles.
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