Hope Alexander MPH

Posts Tagged ‘vertebroplasty’

For Debate

Vertebroplasty for painful acute osteoporotic vertebral fractures: recent Medical Journal of Australia editorial is not relevant to the patient group that we treat with vertebroplasty

William A Clark, Terrence H Diamond, H Patrick McNeil, Peter N Gonski, Glen P Schlaphoff and John C Rouse MJA 2010; 192 (6): 334-337(see link below)

Abstract

We use vertebroplasty for patients with the most severe pain caused by osteoporotic vertebral fractures less than 6 weeks old, and have observed dramatic pain relief in this acute setting.

A recent editorial in the Journal, written by the authors of two recent vertebroplasty trials, suggested that vertebroplasty is not an effective therapy for acute osteoporotic vertebral fractures.

The trials described in the editorial sampled a very different patient cohort to the one that we treat with vertebroplasty.

Our clinical experience and most of the published literature relating to the benefits of vertebroplasty are in striking contrast to the opinions presented in that editorial.

©The Medical Journal of Australia 2010 www.mja.com.au

Vertebroplasty for painful acute osteoporotic vertebral fractures: recent Medical Journal of Australia editorial is not relevant to the patient group that we treat with vertebroplasty
William A Clark, Terrence H Diamond, H Patrick McNeil, Peter N Gonski, Glen P Schlaphoff and John C Rouse.
Med J Aust 2010; 192 (6): 334-337.
http://www.mja.com.au/public/issues/192_06_150310/cla11439_fm.html

Invited editorial presents an accurate summary of the results of two randomised placebo-controlled trials of vertebroplasty
Rachelle Buchbinder, Richard H Osborne and David Kallmes.
Med J Aust 2010; 192 (6): 338-341.
http://www.mja.com.au/public/issues/192_06_150310/buc10020_fm.html

The Consumers Health Forum-nominated consumer representative on the Medical Services Advisory Committee panel reviewing Vertebroplasty, has asked for comments on consumer issues around treatments such as Vertebroplasty (or injection of bone cement into diseased vertebrae such as osteoporotic fractures).

She is keen to ensure that all consumer issues relating to potential Medicare funding for this procedure are considered in the evaluation.

The Question:
Are we aware of any consumer issues relating to the current treatment and management of painful vertebral compression fracture as a consequence of osteoporosis or vertebral malignant tumours?

In a letter to the editor of the Medical Journal of Australia (MJA 2010; 192 (3): 174-17) Paul J Graziotti states that “Vertebroplasty appears no better than placebo for painful osteoporotic spinal fractures, and has potential to cause harm”.

Some years earlier Vertebroplasty was described as “a promising but as yet unproven intervention for painful osteoporotic spinal fractures” by Rachelle Buchbinder and Richard H Osborne (MJA 2006; 185 (7): 351-352). It was further claimed that “Medicare funding could jeopardise the research needed to establish the benefits and risks of this procedure”.

I read elsewhere that the “slurry” they inject into the bones, can leak out and cause even more problems. Therefore I would suggest caution to anyone who may be contemplating this procedure … as yet the evidence is not available.

The Response:
I would be very wary of suggesting that this procedure be funded by Medicare until there is some strong evidence that it works, and does not cause further harm. The way I read it, the evidence is just not there, and the possibility of damage and the “potential to cause harm” has already been established.

Further information about treatment for osteoporotic vertebral fractures can be found on The Health Report ABC National Radio web site here:
http://www.abc.net.au/rn/healthreport/stories/2009/2647587.htm