Vertebroplasty and Kyphoplasty – Inefficient Treatments for Degenerative Spine Disease

Abstract

Osteoporotic vertebral fractures and pathological vertebral lesions are frequent clinical situations causing severe back pain. The pharmacological treatment of the underlying disease and the analgetic treatment of the associated back pain usually do not rid the patient's back pain completely and are insufficient to prevent the fracture-weakened vertebral body from further fracturing with long term consequences for the biomechanical competence of the entire spine. In the last 10 years the minimal invasive treatment options vertebroplasty (VP) and balloon kyphoplasty (BK) have spread quickly because these procedures appeared to be promising treatments to stop the fracture and vertebral lesion associated back pain and to internally stabilize a fractured vertebral body. Numerous published reports on VP and BK appeared to support the notion of an immediate and lasting pain reduction after VP and BK in additon to a prevention of further fracturing of the treated vertebrae. The first three randomized controlled and partly blinded trials have been published this year. Two of these trials demonstrate that VP does not result in a better pain control than a sham operation whereas BK was shown to reduce back pain due to verterbal fractures for at least 12 months. Considering that more than 1.5 million people world-wide have been treated with VP and BK until now this work discusses the recent trials and suggests clinical and academic consequences on the basis of the most recent evidence.

Key words

vertebroplasty - kyphoplasty - balloon kyphoplasty - back pain - osteoporosis

References

• 1 Buchbinder R, Osborne RH, Ebeling PR. et al . A randomized trial of VP for painful osteoporotic vertebral fractures.  N Engl J Med. 2009;  361 557-568
• 2 Grafe I, DaFonseca K, Hillmeier J. et al . Reduction of pain and fracture incidence after kyphoplasty: 1 year outcome of a prospective controlled trial of patients with primary osteoporosis.  Osteoporos Int.. 2005;  16 2005-2012
• 3 Kallmes DF, Comstock BA, Haegerty PJ. et al . A randomized trial of VP for osteoporotic spinal fractures.  N Engl J Med. 2009;  361 569-579
• 4 Kasperk C, Hillmeier J, Nöldge G. et al . Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective non-randomized controlled study.  J Bone Miner Res. 2005;  20 604-612
• 5 Liu JT, Liao WJ, Tan WC. et al . Balloon kyphoplasty versus VP for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study.  Osteoporos Int., Epub June 2009; 
• 6 Wardlaw D, Cummings SR, Meirhaeghe J. et al . Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomized controlled trial.  Lancet. 2009;  373 1016-1024

Correspondence