Researchers wrangle over vertebral compression fracture therapies

Just when the bickering about vertebroplasty and kyphoplasty seemed headed for history, several presentations at the RSNA meeting Sunday rekindled debate over the right fix for vertebral compression fractures.

A paper by Dr. Nobuo Kobayashi, a radiologist at the St. Luke's International Hospital of Tokyo, reported on a new approach: vertebral height augmentation for prophylactic purposes.

Kobayashi and colleagues performed percutaneous vertebroplasty in 89 consecutive patients with osteoporotic fractures between February 2002 and August 2004. Almost 17% and more than 22% of these patients sustained new fractures within three months and one year of treatment, respectively. These new fractures afflicted predominantly superior vertebrae adjacent to previously treated ones.

The investigators performed prophylactic vertebroplasty - cement injection into the vertebral body adjacent to fractured vertebra to prevent new compression fractures - in 80 consecutive patients between August 2004 and October 2005. Only about 6% and 10% of these patients developed new compression fractures at three months and one year, respectively.

"We were sad to see patients coming back soon after sustaining recurrent or new vertebral fractures. Prophylactic cement injection helped reduce significantly the number of these cases," Kobayashi said.

In another study, a team of investigators from the University of Oklahoma's orthopedics department presented preliminary results on the treatment of vertebral compression fractures using allograft bone.

Principal investigator Dr. Amy B. Kirby and colleagues treated 14 vertebrae in 11 patients with osteoporotic fractures between July 2005 and March 2006 with a procedure they dubbed spineoplasty. Insertion of a mesh inside fractured vertebral bodies is combined with injection of a bone graft compound under general or partial anesthesia. All patients have been successfully treated to date, Kirby said.

The procedure, running at an estimated $4100, is expensive compared with vertebroplasty or kyphoplasty. It could represent significant savings, however, if proven effective in the long term. It also could avoid complications derived from the use of cement since it's based on a bone graft, said coauthor Dr. Douglas P. Beall.

In a third study, Dr. Jean Laredo from Paris, spoke about promising results with a new technique called lordoplasty. Lordoplasty could represent a cost-effective alternative to kyphoplasty, according to researchers.