Patients who undergo the percutaneous procedure have medical-grade bone cement injected between collapsed vertebrae.
For their presentation, Dr. Giovanni Carlo Anselmetti and colleagues at the Institute for Cancer Research and Treatment in Candiolo, Italy, reviewed 2,251 cases of osteoporosis and vertebral collapse treated at their institution since 2002.
Dr. Anselmetti told Reuters Health that before any decision about vertebroplasty, all patients were referred for up to three months of rheumatological treatment. "Only then do we select patients that have no other treatment option," Dr. Anselmetti said. "We also perform MRI in every patient so that we know that their pain is due to vertebral fracture and not some other pathology, such as impingement."
In 709 cases, back pain resolved with medical treatment alone. The remaining 1,542 patients underwent percutaneous vertebroplasty, with medical therapy continuing afterward.
The researchers had short-term follow-up data on 1,494 of the surgical patients. Their mean visual analog pain scale score fell from 8.2 before surgery to 1.1 at three months, and their mean Oswestry Disability Questionnaire score declined from 68.7 to 18.5 points (p < 0.0005 for both).
Longer-term follow up of 1,017 patients (averaging 31 months) showed sustained benefits, with a mean visual analog pain scale score of 1.3. Furthermore, 683 of 757 patients (90%) who needed back braces before vertebroplasty no longer used them.
The researchers saw no increase in vertebral fracture risk compared with published reports of patients receiving medical treatment only.
Two randomized trials reported in the New England Journal of Medicine recently -- one with 78 patients and the other with 131 -- failed to show significant benefit from vertebroplasty.
"One problem is that there wasn't optimal patient selection" in those studies, Dr. Anselmetti said. Furthermore, he said, those protocols had not included optimal medical therapy prior to vertebroplasty.
"The key points for best clinical outcome are patient selection and good collaboration between physicians," Dr. Anselmetti concluded.
By Karla Gale
Last Updated: 2010-03-15 13:40:13 -0400 (Reuters Health)
Italian study finds vertebroplasty effective, February 18, 2010
Vertebroplasty provides no advantages for osteoporotic spinal fractures, August 6, 2009
Long-term data show vertebroplasty effective for osteoporotic vertebral collapse, March 19, 2008
Back-extensor strength exercises beneficial after vertebroplasty, February 20, 2008
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