Spinal cement does not help pain, report finds

BMJ Group News

Vertebroplasty is surgery to inject a type of cement into your spine, to strengthen the vertebrae (the bones that make up your spine). It’s done to relieve pain from broken vertebrae.

The most common cause for broken bones in the spine is osteoporosis, where the bones become weak and break easily. Women in particular are vulnerable to getting back pain (and in time becoming shorter) from osteoporosis in the spine.

Osteoporosis can also cause the spine to curve over, so the person can’t stand up straight.

Vertebroplasty has been used to treat fractures since the 1990s, but there has been controversy about how well it works. The National Institute for Health and Clinical Excellence looked at it in 2003, and said it could be used to relieve
pain if other treatments had been tried and hadn’t helped.

At the time, NICE said the evidence showed that most people who had the treatment had some relief from pain. But there has been criticism of some of the studies about vertebroplasty.

What does the new report say?

The new report says that vertebroplasty does not help relieve pain or improve disability, and should not be used.

The authors reviewed all the research about this treatment. The report authors said that, if you look at the highest-quality studies (randomised controlled trials, which compared vertebroplasty with a fake procedure), they show that
vertebroplasty doesn’t help relieve pain any more than the fake procedure.

The report authors say their recommendations are based mainly on two high-quality studies covering 209 patients in total. In these studies, vertebroplasty didn't help with pain.

The authors also looked at three moderate-quality studies, covering 210 patients. One study showed a reduction in pain for people who’d had vertebroplasty in the day after treatment, but by six weeks after surgery, the differences in
pain scores were not big enough for the patients to have noticed a meaningful improvement.

How reliable are the findings?

The authors of the study said they were confident that “future studies are unlikely to overturn the results” of the studies published so far. They classified the evidence against the operation as “strong”.

The two studies that the report recommendation is based on have been criticised. One was criticised for being small and the other for having a ‘crossover’ design, where half the patients had the operation at one point, then half of them
had the operation a month later. However, the smaller study was big enough to show any meaningful reduction in pain. And the crossover design does not explain why the patients who had the operation first had no improvement in pain during the month after surgery.

Overall, this report is likely to be reliable.

Where does the study come from?

The report comes from the American Academy of Orthopedic Surgeons, who published it as a guideline for their members.

What does this mean for me?

If you’ve had this operation already, there’s no need to worry. The report doesn’t suggest it is likely to cause any harm. The evidence about how well a surgical technique works often changes during the years after it’s introduced, and
the surgeons who carried out your operation will have done so in the expectation that it would help.

If you are considering having surgery for back pain from osteoporosis, this report says that vertebroplasty is unlikely to help. You may want to discuss this report with your doctor or surgeon.