Caring Currents

Bad News for Those with Spinal Compression Fractures; Popular Treatment May Not Work After All

Last updated: Aug 10, 2009

Back Pain
Image by Andreanna used under the creative commons attribution license.

For the many older adults who suffer from osteoporosis, one of the most debilitating consequences can be compression fractures in the spine, which are tiny hairline fractures in the vertebrae that happen when bones weaken and can't take the pressure of standing upright. Compression fractures may be small, but they can be incredibly painful, sidelining many folks who were previously active and healthy. Now comes news that a common treatment for this condition, vertebroplasty, doesn't work. Studies published a few days ago in the New England Journal of Medicine found that vertebroplasty, a treatment in which acrylic cement is injected into the the bones to ease the painful cracks, is no better than placebo, or essentially doing nothing.

Two studies, conducted in the U.S. and Australia, tested vertebroplasty in a double-blind placebo-controlled trial, the toughest kind of scrutiny in which patients don't know whether they've had the procedure or not. (For the patients given placebo treatment, they actually mixed the cement, so they'd smell it and think they got it.) Patients were then followed for up to six months, rating their pain levels. Both groups reported equally that their pain was improved.

Vertebroplasty is a popular procedure; last year, about 73,000 Americans had the treatment, which costs $2,500 to $3,000 for the treatment itself and an additional $1,000 to $2,000 for an M.R.I. beforehand. It remains to be seen if doctors will be more reluctant to recommend the procedure and if patients will be less eager to have it. The problem is, it's the only treatment for this condition. Before vertebroplasty, patients were prescribed rest and anti-inflammatory painkillers, and sometimes a back brace. The healing process can take a long time, and some people may not heal completely.

So why not try vertebroplasty anyhow? The problem is, vertebroplasty carries risks. According to a report in The New York Times, there have been serious cases where the cement leaked into blood vessels, damaging the heart and lungs and even causing death. Experts have also questioned whether cementing one vertebra can stress others and lead to more breaks.

Experts say the news that vertebroplasty doesn't work any better than placebo -- which means, in this case, doing nothing -- may tip the scales against the procedure. One danger is that insurance companies and Medicare, which now cover the procedure, may stop doing so.

What's confusing is that many of those who've undergone this treatment swear by it, reporting immediate relief from the pain. One of the study's lead researchers, David F. Kallmes, a radiologist at the Mayo Clinic, is actually one of the doctors who developed the procedure in the first place, and was shocked by the results. More studies are definitely needed, but Kallmes and others say there are three possible explanations they're looking into:

  1. The fractures healed naturally over time, with or without vertebroplasty, at comparatively equal rates.
  2. Patients felt pain relief due to the "placebo effect," in which their belief in the treatment led them to feel better.
  3. The numbing drugs that were injected into patients' spines in both the real and sham procedure had a lasting effect on their pain. (Which might mean such drugs could be used even without the procedure.)

So what should you do if you have compression fractures--or someone you're caring for does? This is an ongoing story, and I'm sure we'll be hearing more about it as doctors try to sort out what this news means for treatment in the future. I'm guessing what will shake out, at least for now, is that doctors will hold off longer on the procedure, trying the traditional treatment of rest, painkillers, and a brace, before recommending it. But for those who don't experience relief after a period of treatment, vertebroplasty may still be worth considering.