Vertebroplasty no better than placebo

Debate surrounds the value of vertebroplasty as a Medicare-rebated procedure for treating painful osteoporotic spinal fractures after two studies found it is no better than placebo. In one study, patients reported similar reductions in overall pain at one week and at one, three and six months, regardless of whether they were randomised to percutaneous vertebroplasty or a sham procedure. Meanwhile, a similar US-led study concluded improvements in pain and pain-related disability were similar between a vertebroplasty and a control group at one month follow-up. Australia's Medical Services Advisory Committee approved interim Medicare funding for the procedure in 2005, with a review due in 2009-2010. Co-author of one of the recent studies, Professor Peter Ebeling, endocrinologist and medical director of Osteoporosis Australia, said the widespread use of vertebroplasty should now be reviewed. "It's up to the government to decide, but they really need to look at [the evidence] carefully when they are reviewing the Medicare schedules," he said. However, a Sydney interventional radiologist, Dr Bill Clark, who performs more than 300 vertebroplasty procedures a year, said the studies were flawed because the majority of participants had fractures of more than six weeks duration. "The selection criteria was wrong, because this is a procedure normally used for people with pain for less than six weeks," he said. "This is a technique for a soft non-healed fracture to glue the fractures together. Why would you try it on a bone that's already rock hard," Dr Clark said. An Australian study comparing vertebroplasty with best conservative treatment for patients with new fractures was currently being developed, he said. New England Journal of Medicine 2009; 361:557-68, 569-79....