Spinal surgery (vertebroplasty) has been deemed just as effective to relieve the pain of osteoporosis as the placebo or the so-called ‘sham’ procedure in older patients, according to a trial by the BMJ.
Osteoporosis is a condition where the bones become weak, leaving them more susceptible to breaks. Fractures caused by the disease more commonly occur in the spine and are called vertebral compression fractures.
One way to treat the pain associated with osteoporosis is by having a procedure known as a vertebroplasty, which involves injecting a special cement into the fractured bone to stabilise it.
However, previous studies have reported conflicting results, and there is ongoing debate about its benefits, risks, and cost-effectiveness.
Resolving the uncertainty
The researchers have said that their results “do not support vertebroplasty as standard pain treatment in patients with osteoporotic vertebral fractures”.
In a bid to resolve the uncertainty surrounding the treatments, researchers in the Netherlands and the USA compared pain relief in patients undergoing vertebroplasty or a ‘sham’ procedure, where patients are given local anaesthetic injections, with no bone cement.
The trial comprised 180 adults over the age of 50 years, with 1-3 vertebral compression fractures of up to nine weeks old. Of the patients, 91 were assigned to vertebroplasty, while 89 were assigned the ‘sham’ procedure.
What did the trial reveal?
Pain was measured using a visual analogue scale (VAS), ranging from zero (no pain) to ten (severe pain). The mean reduction in VAS pain score was statistically significant in both groups at all follow-up points after the procedure, compared with baseline.
It was found that vertebroplasty had no effect on quality of life or on disability.
Researchers said: “Percutaneous vertebroplasty to treat patients with acute osteoporotic vertebral compression fractures did not result in statistically significant more pain relief than a sham procedure during 12 months’ follow-up.”
Where is its place in chronic pain treatment?
Consultant spinal surgeon at Southampton General Hospital, UK, Evan Davies, said in a linked editorial that this trial suggests that vertebroplasty “should not be offered to patients with three or fewer painful osteoporotic vertebral fractures of less than 6-9 weeks’ duration”.
Davies writes, in the meantime, early vertebroplasty before nine weeks “should probably be considered only in exceptional circumstances for patients with vertebral osteoporotic fractures”.
