Navigation Links
Surgery, 'Sham' Equal in Treating Compression Fracture Pain
Date:8/5/2009

Injecting cement into spine no better than placebo procedure, study finds

WEDNESDAY, Aug. 5 (HealthDay News) -- Two new studies suggest that vertebroplasty, a widely used surgery to help heal compression fractures, is no better than "sham" surgery when it comes to relieving pain and improving daily function.

But both procedures resulted in a significant decline in pain, so this is unlikely to signal the death knell for this widely performed surgery, experts noted.

"From a clinician's standpoint, it's important to read this data and be aware of it," said Dr. L. Gerard Toussaint III, an assistant professor of neuroscience and experimental therapeutics at Texas A&M Health Science Center College of Medicine and a neurosurgeon at Texas Brain and Spine Institute in Bryan.

Vertebroplasty involves injecting a type of "cement" into the spine to stabilize it, thereby relieving pain and reducing disability in people who have had osteoporotic fractures.

The procedure is minimally invasive and often performed under local anesthetic, with the patient going home the same day, Toussaint said.

In the United States alone, some 750,000 people have vertebral compression fractures each year. According to an editorial that accompanies the studies, all appearing in the Aug. 6 issue of the New England Journal of Medicine, the number of vertebroplasty procedures performed in the United States has doubled in the past six years, from 4.3 to 8.9 per 1,000 people.

Several studies have found great benefit from the procedure, but none of those were placebo-controlled.

Experts also worry that there may be a downside, with the surgery putting patients at higher risk for future fractures.

One trial, from Mayo Clinic researchers, randomly assigned 131 patients who had had one-to-three osteoporotic vertebral compression fractures to receive either vertebroplasty or a "sham" surgery without cement.

Those in the placebo arm went through the motions of surgery, including being brought into the procedure room and being sedated before surgeons put novocaine in the skin and over the bone, said study author Dr. David F. Kallmes, a professor of radiology at the Mayo Clinic in Rochester, Minn.

After one month, both groups had experienced a similar, and significant, reduction in pain.

"Like every other trial, patients with vertebroplasty gained substantial benefit. Pain was cut almost in half," Kallmes said. "To our shock and amazement, however, there was no difference in pain relief, function or quality of life between the groups."

The second study, done in Australia, used essentially the same methodology with 78 participants.

Again, there were significant and similar declines in pain and other measurements in both groups six months after surgery.

"We conclude that the procedure seems to work but not apparently because of the cement," Kallmes said.

It could be the placebo effect or something as simple as the effect of the novocaine on the bone, breaking the cycle of pain, he added. Kallmes is currently enrolling patients in a trial to see if novocaine on the bone gives the same benefit as vertebroplasty.

But even now, many physicians do not favor vertebroplasty as the first-line treatment.

"I think we should take the middle road," Kallmes said. "We should discuss with the patient in a completely informed manner what the options are, and I think we have options. I still counsel patients that they should try ongoing medical therapy but I don't think it's unethical to do the procedure at this point. I think it's suboptimal."

"I always try bracing and analgesics and physical therapy to try to get the patients to feel better without any intervention at all," Toussaint added. "But if those measures don't work, I still think it is an option."

Also, Toussaint noted, "a lot of patients can't get their insurance companies to pay for medications that are more effective for osteoporosis treatment because they're expensive and new, but they will pay for the surgery."

More information

The Radiological Society of North America has more on vertebroplasty.



SOURCES: David F. Kallmes, M.D., professor, radiology, Mayo Clinic, Rochester, Minn.; L. Gerard Toussaint III, M.D., assistant professor, neuroscience and experimental therapeutics, Texas A&M Health Science Center College of Medicine, and neurosurgeon, Texas Brain and Spine Institute, Bryan, Texas; Aug. 6, 2009, New England Journal of Medicine


'/>"/>
Copyright©2009 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. State Report Ranks LIJ as New Yorks Best for Heart Bypass Surgery, North Shore University Hospital Tops for Emergency Angioplasty Survival
2. Park Meadows Cosmetic Surgery, a Pioneer in DIEP Flap Breast Reconstruction Surgery in Colorado, Introduces New, Informative Website
3. Surgery, Anesthesia & Your Brain, Not the Cache of Sex, Drugs, and Rock n Roll
4. Neurological Surgery, P.C. of Long Island, NY Announces the Addition of Pediatric Neurosurgeon, Elizabeth M. Trinidad, M.D.
5. Dr. Karen E. Boyle Joins Chesapeake Urology Associates as Director of Reproductive Medicine and Surgery, Sexuality and Aesthetics
6. USHIFU, LLC Completes Acquisition of Focus Surgery, Inc.
7. Croft & Bender Advises Atlanta-based Alliance Surgery, Inc. in Its Acquisition by HealthMark Partners, Inc. of Nashville
8. Use of intraoperative MRI adds time but care-changing information to neurosurgery, study shows
9. Donde West Likely Killed by Need to Control Postop Pain After Cosmetic Surgery, States Dr. Barry Friedberg, a Globally Recognized Leader in Cosmetic Surgery Anesthesia.
10. Donde West Death Highlights Unnecessary Risk of General Anesthesia for Cosmetic Surgery, Asserts Dr. Friedberg
11. OHSU researchers: Surgery, radiation gives early survival advantage in bile duct cancer
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Surgery, 'Sham' Equal in Treating Compression Fracture Pain
(Date:10/13/2017)... , ... October 13, 2017 , ... “The Journey: From ... every danger possible to save lost souls in the Philippines. “The Journey: From the ... is a dedicated teacher of the Bible. She has taught all ages and currently ...
(Date:10/12/2017)... ... October 12, 2017 , ... Planet Fitness, one of the largest ... its plans to open a flagship location in Covington, LA at 401 N. U.S. ... Go store next to Office Depot in the Holiday Square shopping center. Its location ...
(Date:10/12/2017)... ... October 12, 2017 , ... Asante, a nationally ... care, have expanded their existing home health joint venture through an agreement, effective ... operating a joint venture home health company with Asante, delivering clinically integrated care, ...
(Date:10/12/2017)... ... October 12, 2017 , ... Leading pediatric oncology experts at Children’s National ... 49th Congress of the International Society of Paediatric Oncology (SIOP) Oct. 12-15. ... for Cancer and Blood Disorders at Children’s National, and Stephen P. Hunger, M.D., ...
(Date:10/12/2017)... ... October 12, 2017 , ... In the ... a year. In some states—like New York, New Jersey, Massachusetts, Texas, Virginia, Connecticut, ... retirement havens have extremely low property-tax rates, which contributes to the relatively lower ...
Breaking Medicine News(10 mins):
(Date:9/28/2017)... -- Hill-Rom Holdings, Inc. (NYSE: HRC), will host its ... on Friday, November 3, 2017, beginning at 7:00 a.m. ... 8:30 a.m. (CDT) / 9:30 a.m. (EDT). ... and guidance for 2018, Hill-Rom executives will also highlight ... and long-range financial outlook through 2020. ...
(Date:9/27/2017)... and NEW YORK , Sept. 27, 2017  DarioHealth ... and big data solutions, today announced that its MyDario product is expected ... local TV listings for when The Dr. Oz Show airs in your ... The nine-time Emmy ... ...
(Date:9/23/2017)... Sept. 22, 2017 Janssen Biotech, Inc. (Janssen) ... letter from the U.S. Food and Drug Administration (FDA) ... sirukumab for the treatment of moderately to severely active ... clinical data are needed to further evaluate the safety ... active RA. ...
Breaking Medicine Technology: