SIR: Long-Term Pain Relief Found with Vertebroplasty

SEATTLE, March 8 -- Percutaneous vertebroplasty reduces pain of collapsed vertebrae without increasing risk of new fractures over the long term, according to Italian researchers.

Among 1,005 consecutive patients who had a cement injected into frail vertebrae, pain dropped a clinically relevant 6.5 points on the 11-point visual analog scale (P

After three to 51 months of follow-up, 13.4% of patients with osteoporosis had a new vertebral fracture (average 9.4 months after vertebroplasty). Most new fractures were in vertebra adjacent to those strengthened (68.8%, P=0.0004) without a significant difference in occurrence above or below the treated vertebrae (P=0.1).

The rate of retreatment for fracture compared favorably to published rates for placebo (18.9%, P=0.09) and medical osteoporosis treatment with 20 ?G teriparatide (Forteo, 11.2%, P=0.3) or 40 ?G teriparatide (10.4%, P=0.17).

The complication findings were:

• 2.3% of patients had a minor complication (16 asymptomatic pulmonary embolism, six nerve root irritation, and one needle tip rupture),
• 0.3% had a major complication (one each for subcutaneous ematoma, local skin infection, and spondylitis),
• 31.2% of patients had asymptomatic leakage of the vertebroplasty material into the veins (36.8% of vertebrae),
• 15.5% had asymptomatic leakage into the disc.

Dr. Anselmetti chalked up the "very low" complication rate to their use of state-of-the-art imaging systems.

"As our data do not show any increased risk of a new fracture compared to placebo and medical therapy," he said, "a prospective randomized trials have to be performed to assess if [percutaneous vertebroplasty] in the future will be consider as 'conventional therapy' in the treatment of painful vertebral fractures."