Authors' objectives:

This study provides a summary of systematic reviews of percutaneous vertebroplasty for pain relief in the management of compressive vertebral fractures.

Authors' recommendations: Low level (IV-V, i.e. case series and expert opinion) evidence shows that, with careful patient selection, percutaneous vertebroplasty (PV) can reduce pain due to compressive vertebral fractures. The best candidate for PV appears to be those patients with severe non-radiating pain centered on or immediately adjacent to a compressed vertebral body accompanied by imaging evidence of a new or progressive vertebral compression fracture. At present, there are no randomized controlled trials (RCT) that demonstrate any benefit of PV over conventional medical management in reducing pain due to compressive vertebral fractures. Given the relatively low cost of the procedure and the relative effectiveness in reducing pain, there may not be many RCT against conventional medical management being conducted. There is one randomized controlled trial listed in the National Research Register, UK, entitled 'A randomized controlled trial of vertebroplasty for the treatment of osteoporotic vertebral crush fracture'. The study is being conducted from May 2002 - May 2004. No further information is provided about this trial at present. Given the above evidence on the relief of pain, either immediate or during follow-up, it is important to take into account the fact that: - patients in these series were more likely to get the treatment at the height of their pain. It is well known that, across time, this pain may subside due to the natural course of the disease process itself. Thus, a 'regression toward the mean' phenomenon may be involved in the observed pain reduction during follow-up - placebo effect is well known in the area of pain study. The placebo effect cannot be measured at all in a case series due to the lack of controls At present, there is no long-term study available nor is one planned (that we are aware of) that has or will look at the potential long term adverse effects of this procedure.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.worksafebc.com/health_care_providers/related_information/evid ence_based_medicine/default.asp

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: WorkSafeBC

Contact Address: 6591 Westminster Highway, Richmond, BC, V7C 1C6 Canada. Tel: 604-231-8417; Fax: 604-279-7698

Contact Name: ebpg@worksafebc.com

Contact Email: ebpg@worksafebc.com

Copyright: WorkSafe BC