My best friend Hal had Schurmans as a kid. Unless x-ray findings suggest significant weakening of the vertebral bodies, I would use the same techniques I use on every other patient. Hal tolerated diversified care and Pierce-Stillwagon very well…in fact, that’s what kept him asymptomatic.

Thank You

What amazes me is how many people are okay to jump into this – but are deathly afraid of having their necks “cracked”.

Have you ever heard of failed back syndrome?

While your playing online, go to PubMed (the depository for PEER-REVIEWED literature) and do a search. What you’ll find is that many of those people experienced short-term relief BEFORE they crash and burn.

You don’t see a difference between reporting responses 2 days after, versus 3 MONTHS after a procedure? I hardly know what to say.

Finally, you didn’t really address any of my concerns.

Anyone can “say” anything they like about surgery, or how to make a million bucks in the next 2 weeks. But that doesn’t make it so, does it?

The whole point of peer-review (flawed though it may be) is to review the methods and analysis of a paper BEFORE it gets into the hands of the easily impressed.

Until then, please don’t use this website as a pulpit to propound opinions that have not withstood rigorous scrutiny. I suspect that neither of us are surgeons, so let’s leave the opinions to those who “stood the test” of peer-review (like at NEJM).

2. Dr. Hendrich Franzen of Belgium went to a presentation on this study and here is a summary of his notes:

Pain relief was 87% for Vertebroplasty VAS went down in average for 5.7 points! For CT the pain reduction took much more time and it never equaled the VAS of VP. She showed a graph comparing both and the difference was very impressive.

She mentioned that in the NEJM study it was only 2 to 3 points VAS reduction. She also said that in the NEJM the patients did not have much pain (4 or 5 and compared to 7/8 and more in the Vertoss II study).

They compared cost and quality of life . After 1 month and 1 year the results were much better for VP than for CT.

Adjacent fractures:
15% in VP versus 24% in CT

This is the first result after 1 year but they will follow-up the patients until 2 years.

Also, she mentioned that the randomization was blind and organized by an external clinical laboratory.

3. These items have not been published in their entirity; I expect they may frequent the pages of NEJM before long (my prediction, of course). The full findings were presented at CIRSE and are supported by the majority of those who review, including NASS, AJNR, SIR, AANS, ASSR and others. More to come…

Thanks for your posting(s). I have several issues with them:

1. The first study reports on pain relief 2 days after the procedure. That is hardly informative, and certainly does NOT predict long-term outcome, which I believe was the point of Dr. Pate’s article.

2. The second posting does nothing at all to justify Vertebroplasty. It’s a status report on an unfinished review, and it’s very unclear if it will be a rigouous meta-analysis, or just another “feel good” advertisment by surgeons to justify unproven surgeries.

3. Finally, neither of them are from a peer-reviewed journal. If these are from trade papers, or from one of the (numerous) spurious pseudo-journals we have posted about in the past, then neither of them come up to the shoe laces of the NEJM posting (in my humble opinion).

I hope you don’t mind my cleaning up your postings, so that they were readable.

Topic: Bone and soft tissue intervention

Monday, Sep 21, 2009, 4:25 PM – 4:35 PM

Author(s): C. Klazen1, P. Lohle1, F. Jansen2, M. Schoemaker1, O. Elgersma3, K. van
Everdingen4, H. Fransen5, T. Lo6, A. Tielbeek2, W. Mali6;

Purpose: presenting the results of a randomized controlled trial (RCT) comparing clinical outcome
and cost-effectiveness of vertebroplasty (VP) versus conservative therapy (CT) in patients with
painful osteoporotic vertebral compression fractures (VCF).

Materials/methods: a prospective, multicenter RCT was conducted in the Benelux in November
2005.

Inclusion criteria: VCF with bone edema on MRI, local back pain (<6 weeks), age of 50 years
or older and osteopenia. A total of 200 patients are randomized, 100 in each arm. Radiological
imaging results and standard questionnaires addressing clinical symptoms, pain medication and
visual analogue scale (VAS) will be compared to baseline and between groups. Significant pain
relief is defined as a reduction in VAS-score of 50% or more. Cost-effectiveness of both therapies
will be obtained and compared. Follow-up is at regular intervals over 1-year period. Secondary
fractures, necessary additional therapies and complications of both treatments are recorded.

Results: 1-year results will be obtained in July 2009 and presented at this year’s CIRSE meeting including clinical results, cost-effectiveness, complications and adverse events.

Conclusion: first-time presentation of the Vertos II results, the world’s first large RCT designed to assess the
value of VP in patients with acute osteoporotic VCF.

Topic: Bone and soft tissue intervention

Monday, Sep 21, 2009, 4:51 PM – 5:00 PM

Author(s): S. Marcia1, G.C. Anselmetti2, G. Bonaldi3, P. Carpeggiani4, S. Masala5, M.
Muto6, S. Marini1, A. Manca2;

Purpose: the purpose of this work was to retrospectively evaluate results and complications of
percutaneous vertebroplasty performed in 6 different Italian centers belonging to the European
Vertebroplasty Research Team (EVEREST) in a large series of patients.

Materials and methods: four thousand five hundred forty-seven patients (3211 females and 1336
males; mean age 70.2 years) underwent percutaneous vertebroplasty (PV) for a total of 13,437
treated vertebrae. Exams were performed by using fluoroscopic guidance or combined
CT-fluoroscopic guidance. All patients underwent local anesthesia except for cervical vertebras
treated with trans-oral approach.

Results: four thousand and four of 4547 (88.06%) patients had significant pain relief (difference >
or = 2 point in pain evaluated with an 11-point visual analog scale; p<0.0001) within 48 hours: an
average of 7.7±0.4 dropped to 1.8±0.6 in the osteoporotic patients; 8.3±0.4 to 2.4±0.4 in metastases;
8.3±0.4 to 1.7±1.0 in myeloma; 6.2±3.5 to 0.3±0.2 in hemangioma and 7.4±0.4 to 1.4±0.9 in trauma.

Four-hundred-thirty osteoporotic patients (13%) were retreated for a subsequent fracture; in 302/430
patients (70.2%), the new fracture occurred in the contiguous vertebra. No major neurologic
complications were reported and venous leakage was the most frequent mild one (20.5%).

Conclusions: the large series of patients confirms that percutaneous vertebroplasty is an effective
and safe procedure in the treatment of vertebral fractures, especially when high-quality radiologic
guidance is used. Best results are obtained in the treatment of myeloma and osteoporosis.