The vertebroplasty controversy

Abstract

Two recent articles published in the New England Journal of Medicine have put the proverbial cat among the pigeons in the spinal community. Both the articles report results of investigation into vertebroplasty. Vertebroplasty entails the percutaneous injection of polymethylmethacrylate (PMMA) into the affected vertebral body and has been advocated as a treatment for painful osteoporotic vertebral fractures. Many previous studies have shown that there is an immediate and sustained reduction in pain after this procedure is performed. Randomised trials have been done that have confirmed the efficacy of this procedure. None of the previous studies have been randomised double-blind controlled studies with a sham control group. The procedure has become very popular in treating these fractures and has been very positively received by treating physicians. I have found this procedure to be very successful in treating my patients with vertebral compression fractures, as have many of my colleagues. For this reason, the results of the articles below have been met with surprise and disbelief.