Spine

In 2002 there were approximately 200 papers on vertebroplasty and kyphoplasty. Today there are more than 2500. In 2009 and 2010 the FREE and VERTOS II studys were published in the Lancet. These studies concluded that balloon kyphoplasty and vertebroplasty were safe and effective in the treatment of acute fractures.^1,2 In 2009, 2 papers were published in the New England Journal of Medicine that claimed that these procedures were of no benefit.^3,4 However, many of the patients included in these studies had chronic fractures and were therefore unlikely to benefit from cement augmentation.

In February a paper was published in the British volume of the JBJS by Longo et al.⁵ They set out to standardise best practice conservative management against which cement augmentation procedures can be judged, and they discuss bracing at length. The problem with braces is that half the population are the wrong shape, and the other half struggle to tolerate them. Consequently compliance is poor. In my practice I reserve cement augmentation for patients who are unable to get out of hospital due to pain, patients with pain and progressive deformity, and for patients who have persisting pain lasting for more than 6 weeks. I am not convinced that a comparison with bracing is going to give us the definitive answer. The debate continues.

Mr James Langdon Consultant Orthopaedic and Spinal Surgeon, West Herts Hospitals NHS Trust, UK.

References

1. Wardlaw D, Cummings S, Van Meirhaeghe J, et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 2009;373:1016–24.
2. Klazen C, Lohle P, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 2010;376:1085–92.
3. Kallmes D, Comstock B, Heagerty P, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009;361:569-79
4. Buchbinder R, Osborne R, Ebeling P, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 2009;361:557-68
5. Longo U, Loppini M, Denaro L, et al. Conservative management of patients with an osteoporotic vertebral compression fracture. J Bone Joint Surg [Br] 2012;94-B:152-7.

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