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Vertebroplasty From An Australian Perspective

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Vertebroplasty From An Australian Perspective

I have heard both good and bad about using vertebroplasty to help relieve nerve compression and pain caused by myeloma related complications.  Let’s see what the Australians have to say about the procedure:

Vertebroplasty backed despite criticisms
Tony James – Rheumatology Update

The Interventional Radiology Society
of Australia has hit back at
recent criticisms of vertebroplasty,
recommending the procedure
be used judiciously in patients
with acute spinal fractures.

In a strongly-worded position
statement, the society
objected to a recent editorial
by Monash University’s Professor
Rachelle Buchbinder, who
cited two recent randomised
controlled trials as evidence that
vertebroplasty was not effective.

“It is interesting to note that this
editorial was printed without any
request for review by diagnostic
or interventional radiology,
and without consultation with
IRSA,” the statement said.

The lead author of the statement
was Sydney radiologist
and IRSA treasurer, Dr William
Clark, who was also an investigator
on one of the trials cited
by Professor Buchbinder.

In the statement, Dr Clark said
he had “repeatedly expressed
his opinion that the patients
enrolled in [his] trial did not
represent the typical patient
selection in that hospital”.

He claimed “clinical experience
in Australia” showed acute
fractures (less than six weeks old)
responded well to vertebroplasty.

By contrast, his trial and the
other one study cited by Professor
Buchbinder had enrolled patients
with chronic back pain for up to
a year, and the average duration
of the fracture was 14.7 weeks
at the time of randomisation.

“We estimate 75% of the
enrolled patients had what
we would define as non-acute
fractures. There is no theoretical
mechanism for vertebroplasty
to be effective in these bonded
fractures, so the negative results
of these trials were not unexpected,”
he said in the statement.

“On the sum of current
evidence, we recommend the
application of vertebroplasty
be restricted to acute vertebral
fractures less than six weeks old,
in patients in whom the symptoms
of severe pain and immobility
are not adequately controlled
by conservative therapy.”

Journal of Medical Imaging and radiation Oncology 2011; 55: 1-3.

Although this article isn’t specific to bone involvement (damage) caused by multiple myeloma, it certainly applies to us.

When I saw an orthopedic surgeon for a consult about my deteriorating lumbar area, he didn’t seem to think there was any hurry.  Goes against the “six week” time frame recommended by this Australian group.

Feel good and keep smiling!  Pat