Vertebroplasty for Osteoporotic Compression Fracture: Effective Treatment for a Neglected Disease

I read with great interest the editorial of Jarvik et al (1) in the September 2000 issue of AJNR, and feel compelled to respond with my thoughts and experience. Contrary to Dr. Jarvik's assertion that vertebroplasty is a “technique for treating low back pain”, it truly is only a procedure for treating painful, unhealed, osteoporotic compression fractures of the spine. Dr. Jarvik apparently has little experience with the technique or with the dramatic results achieved in the great majority of individuals treated.

Conventional treatment for painful osteoporotic fractures of the spine typically includes bed rest, narcotic analgesics, and occasionally bracing. Many patients respond, but there is a subset who have persistent debilitating pain and resultant reduction in quality of life and medical complications of prolonged bed rest. Many require hospitalization or nursing home admission. Patents with untreated osteoporotic vertebral body fractures have been shown to have a 23% to 34% greater mortality than those treated in a recent study that followed such patients for 8 years (2).

My experience, and that reflected by others (3), suggests that vertebroplasty is a safe, relatively inexpensive, and highly efficacious treatment of a vexing problem for which there is no other treatment aside from a modified version of benign neglect. There are large numbers of patients who have been able to resume their active lifestyle, discontinue narcotic medication, and function independently.

The question of evaluating long-term outcomes is interesting but not valid in patients whose life expectancy may be significantly shortened. Even 1 year of painful existence in a patient with 3 years to live represents a very substantial benefit with very little risk and cost.

I question Dr. Jarvik. How would a randomized controlled study be designed that didn't exclude patients form an effective treatment for a potentially life-threatening disease?

Would a new treatment for fracture of the hip or radius require an untreated control group to prove long- term efficacy? What possible outcome of a prospective randomized study of vertebroplasty would result in any change in the practice of those of us performing this procedure?

For ethicists to insist that “we stop”, merely to add pedantic scientific evidence to the demonstrated efficacy of the vertebroplasty procedure, flies in the face of common sense and compassion