Percutaneous Vertebroplasty is Not for Everyone

  • Osteoporotic vertebral compression fractures can create a challenging state of chronic pain and disability. The challenge is for both the physician who is scratching his/her head and for the tearful man or woman who is lying on the gurney in pain. The temptation is to be aggressive early by utilizing one treatment option called the percutaneous vertebroplasty which involves the injection of cement into the vertebral body.  This procedure is meant to stabilize the fracture and relieve pain quickly. And in fact, this invasive treatment of a compression fracture can relieve pain substantially within the first 24 hours; however, a vertebroplasty is not for everyone.

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    The vertebroplasty procedure was first utilized in 1980. Since then, this procedure has become a popular option for treating spinal fractures due to osteoporosis. Before this procedure was developed, traditionally such fractures were treated with rest, bracing, and physical therapy.  In a recent study from Denmark, researchers sought to find out if the vetebroplasty, was a better option than the traditional, conservative, non-invasive treatment. Indeed, they did find that the pain relief from a vertebroplasty was superior to conservative treatment in the first month. However, at 3 months and 12 months after the event, people who only had conservative treatment were doing just as well as those who had the vertebroplasty procedure. Over the long run, treating a vertebral fracture with precutaneous vertebroplasy offered no advantage over the traditional, conservative treatment.  

     

    But, when someone is lying on the emergency room gurney, why not offer vetebroplasty to everyone if the pain relief is so immediate? Well, this invasive procedure is not without risks. Initially, it was thought that the presence of hard cement would increase the fracture risk in adjacent levels. That theory has been disproven. The risk for additional fractures is not higher with vertebroplasty versus the natural, osteoporotic spine. However, there are other real risks. Cement leakage is the most common cause of complications. Loose pieces of cement floating around can lead to serious problems like neurologic compromise and pulmonary embolism. These major complications are rare, but do exist.

     

    Taking these risks into account, the conclusion from the Denmark study is that "Percutaneous Vertebroplasty should not be performed in acute (less than 2 weeks old) or subacute patients (2-8 weeks old) for reasons of long-term effects, but possibly to mediate pain relief in the weeks following the fracture when conservative treatment is insuffient." They go on to recommend early (prior to 8 weeks since fracture) percutaneous vertebroplasty only in those who are too sick or weak to tolerate conservative treatment. Because of the risks, vertebroplasty is not for everybody.

     

Published On: April 26, 2010