Vertebroplasty – worth a rethink

A brief history

Vertebroplasty is a procedure of injecting acrylic bone cement into a vertebra to treat a fracture.

It was first used in 1984 at the University Hospital of Amiens (France) to fill a void created by a benign spinal tumour. The procedure was rapidly taken up by the international medical community to treat both tumours and vertebral compression fractures, primarily caused by osteoporosis.

Compression fractures are relatively common and can be very painful. The apparent success of the procedure ensured its popularity.

Do they work?

However, questions lingered, and in 2009 two independent placebo control trials were conducted – one in the US and the other in Australia. They both found there was no benefit in those with osteoporosis-related fractures.

As a result, the federal government removed the medical benefits for this procedure.

But the Jury is still out  

But still, the controversy reigned. Proponents of the procedure were concerned that:

• The trial was across a wide range of age of fractures; of which early stage vertebral compression was just a small selection.
• The volume of cement used – 2.7cc – was two to three times less than the recommended volume.

So, between 2011-2014, a further Australian trial was conducted across four Sydney hospitals.

Published in August 2016, the VAPOUR trial found there were pain relief benefits for vertebral compression fractures caused by osteoporosis if treated within six weeks of onset and pain was severe enough to warrant hospital admission.

As a result, the federal government is reassessing the findings and considering sanctioning the use of vertebroplasty in limited situations. But as of yet, there is no money for it.

Vertebral fractures are painful. What to do?

Typically, 30% of compression fractures end up with chronic pain.

1. If your patient is in recent and severe pain:

Have them admitted to the aged care unit at a hospital. They can arrange a pain management program, and the patient needs supervising by a hospital geriatrician. There are some unpleasant side effects of some pain management regimes.

2. If pain has been going longer than six weeks:

Refer them to a spinal surgeon for a more comprehensive review and diagnosis. Though surgery is only recommended in extreme circumstances.

3. Being proactive is crucial.

If your patient has been diagnosed with a vertebral compression fracture then have a bone density assessment done and start treatment for osteoporosis, because it reduces the risk of a second fracture by more than half.

Subsequent compression fractures magnify the risk of further fractures.

As always if you have any questions about a patient, please feel free to get in touch on 02 9650 4893. I will return your call and discuss how we can help.

And if there’s a topic you’d like to see covered in a future newsletter, just let me know.

You can also reach me via ralphstanford@powspine.com.au.

Dr Ralph Stanford is a spinal surgeon with over 20 years’ experience. He is adept in all surgical approaches to successfully treat his patients.

Dedicated to lifelong learning and sharing his expertise with others, Ralph attends spinal conferences worldwide and regularly consults with colleagues about successful treatments.

As a teacher Dr Ralph Stanford is Conjoint Senior Lecturer at the University of New South Wales; Supervisor of Training for Orthopaedic Trainees, Prince of Wales Hospital; and Education Secretary for the Spine Society of Australia.

As a researcher and scientist, he is a well published author and Honorary Senior Scientist at Neuroscience Research Australia (NeuRA). He is also a current member of Spinal PFET.

Posted 6 November 2019