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Why we should stop performing vertebroplasties for osteoporotic spinal fractures
Author(s) -
Buchbinder Rachelle,
Busija Lucy
Publication year - 2019
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14628
Subject(s) - medicine , quality of evidence , pulmonary embolism , adverse effect , placebo , spinal cord compression , intensive care medicine , evidence based medicine , spinal manipulation , perforation , physical therapy , surgery , randomized controlled trial , low back pain , spinal cord , alternative medicine , materials science , pathology , psychiatry , punching , metallurgy
Abstract While vertebroplasty enjoys continued use in some settings, there is now high‐moderate quality evidence based on systematic review that includes five placebo‐controlled trials that it provides no benefits over placebo and these results do not differ according to pain duration (≤6 vs >6 weeks). A clinically important increased risk of incident symptomatic vertebral fractures or other serious adverse events cannot be excluded due to small event numbers. Serious harms including cord compression, ventricular perforation, pulmonary embolism, infection and death have been reported. This unfavourable risk–benefit ratio should be convincing doctors and patients to stop the use of vertebroplasty. At the very least, clinicians should fully inform their patients about the evidence including the likelihood of improving without vertebroplasty and the potential harms, so that patients can make evidence‐informed decisions about their treatment. They should also warn patients about the pitfalls of relying on information sourced from the internet or from ‘awareness raising’ campaigns.