Surgery provides fast short-term relief from vertebral fracture pain
MedWire News: A literature review conducted by the International Osteoporosis Foundation concludes that vertebroplasty (VP) and balloon kyphoplasty (BKP) provide quicker pain relief and mobility recovery than non-surgical management (NSM) of patients with vertebral compression fractures (VCFs).
But "BKP and VP should not be considered as substitutes for the medical management of osteoporosis," caution Kristina Åkesson (Lund University, Malmö, Sweden) and co-members of the Fracture Working Group of the International Osteoporosis Foundation.
The group explains that VCFs are the most prevalent fractures in osteoporotic patients.
Conservative treatment of these fractures is typically through rest, pain medication, bracing, and muscle relaxants. VP and BKP are two minimally invasive techniques that consist of inserting a bone cement into the compressed vertebra and stabilizing the fracture.
In their review of 17 prospective controlled studies involving a total of 1467 patients, Åkesson and team compared the efficacy and safety of VP and BKP with that of non-surgical management.
Efficacy was measured by the potential to reduce back pain, improve quality of life and physical function, increase vertebral body height, and improve kyphotic angle, while safety was assessed by reported surgical complications, namely symptomatic cement leakage, and incidence of new vertebral fractures.
The researchers found that overall, "VP and BKP are generally safe procedures that provide quicker pain relief, mobility recovery and in some cases vertebral height restoration than conventional conservative medical treatment, at least in the short term."
However, the long-term benefits and safety, in terms of risk for subsequent vertebral fractures, were unclear, and further prospective randomized studies are needed, write Åkesson et al in the journal Osteoporosis International.
They add that such studies would require standardized and systematic reporting criteria to ensure comparability of data, because the heterogeneity observed among the studies in the current review "precludes general conclusions."
Åkesson stated: "Referring physicians should be aware that VP and BKP are available options for the management of vertebral compression fractures, with possible clinical benefits to their patients in terms of acute pain relief and improved quality of life.
"However, longer follow-up of patients are needed to ensure the efficacy and safety of these techniques, which should not be considered as a substitute for the medical management of osteoporosis, vitally needed in these patients at high risk of other fractures."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Laura Dean