A report published in the Journal of Bone and Mineral Research showed little to no evidence that vertebroplasty and balloon kyphoplasty reduce pain compared with non-surgical or placebo procedures.
“The message for doctors and their patients suffering from painful spinal fractures is that procedures to stabilize spinal fractures should not be a first choice for treatment,” Peter R. Ebeling, MD, a member of the American Society for Bone and Mineral Research task force and head of the department of medicine in the school of clinical sciences at Monash University in Australia, said in a press release. “While patients who had these surgeries may have had a short-term reduction in pain, we found that there was no significant benefit over the long-term in improving pain, back-related disability and quality of life when compared with those who did not have the procedures.”
The task force found five randomized placebo-controlled trials showed no clearly significant benefit in pain control with the use of vertebroplasty compared with placebo or sham procedures. The report also argues against the use of balloon kyphoplasty based on the lack of placebo-controlled trials and the absence of any benefits of kyphoplasty over vertebroplasty when compared in a small number of head-to-head trials. Despite being minimally invasive procedures, the task force noted risks of infection at the injection site, cement leakage and complications associated with elderly patients undergoing anesthesia, as well as the concern of increased risk of fractures in vertebrae around the fused area.
“This report makes it clear that these procedures are not a magic bullet,” Bart Clarke, MD, president of the American Society for Bone and Mineral Health and professor of medicine at the Mayo Clinic, said in the release. “Until now, doctors have been left to sift through the data on their own to determine whether these procedures can benefit their patients. This report coalesces all that information concisely and provides recommendations to guide them.”
Ebeling PR, et al. J Bone Miner Res. 2019;doi:10.1002/jbmr.3653.
Disclosures: The authors report no relevant financial disclosures.