Journal scan

Sham operation casts doubt on back treatment

Surgery to repair spinal fractures was no more effective than a sham procedure in older patients with osteoporosis, with both sets of patients saying their pain was reduced

Picture: Alamy

Surgery to repair spinal fractures, or vertebroplasty, is no more effective for pain relief than a placebo procedure in older patients with osteoporosis, a trial shows.

Vertebroplasty involves injecting a special cement into fractures in the spine, which are common in osteoporosis, to stabilise the break and relieve pain.

There has been conflicting evidence over the effectiveness of the procedure to treat the fractures, which can lead to deformity, breathing problems and loss of height.

3 million

More than three million people in the UK are estimated to have osteoporosis, a condition that causes around 500,000 broken bones every year.

Source: National Osteoporosis Society

Researchers in the Netherlands and the US looked at pain relief in patients undergoing vertebroplasty and compared it with a ‘sham’ procedure, where patients were given local anaesthetic injections but no bone cement was inserted.

Not supported as standard treatment

The trial involved 180 adults aged 50 or older, with between one and three painful vertebral compression fractures that had occurred in the past nine weeks. 

The mean reduction in pain score was statistically significant in both groups at all follow-up points up to a year after the procedure. There was little difference between the two groups and vertebroplasty had no effect on quality of life or on disability.

The researchers say their results ‘do not support vertebroplasty as standard pain treatment in patients with osteoporotic vertebral fractures’. But they believe there is a place for vertebroplasty ‘when efficacy outweighs the risks’.

Firanescu C et al (2018) Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV): randomised sham controlled clinical trial. BMJ. doi: 10.1136/bmj.k1551 

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