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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 7/2019

01-07-2019 | Osteonecrosis | Clinical Investigation

Percutaneous Vertebroplasty is no Risk Factor for New Vertebral Fractures and Protects Against Further Height Loss (VERTOS IV)

Authors: Cristina E. Firanescu, Jolanda de Vries, Paul Lodder, Marinus C. Schoemaker, Albert J. Smeets, Esther Donga, Job R. Juttmann, Caroline A. H. Klazen, Otto E. H. Elgersma, Frits H. Jansen, Irene van der Horst, Marion Blonk, Alexander Venmans, Paul N. M. Lohle

Published in: CardioVascular and Interventional Radiology | Issue 7/2019

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Abstract

Background

Percutaneous vertebroplasty (PV) is an alternative option to treat pain after an osteoporotic vertebral compression fracture (OVCF). Controversy exists as to whether PV increases the risk of new OVCFs or prevents further vertebral height loss in treated levels. We assessed both during 1-year follow-up in patients with acute OVCF randomised to PV or a sham procedure.

Methods

VERTOS IV is a prospective, multicentre, randomised controlled trial comparing PV with sham therapy in 180 patients. New OVCFs and further vertebral height loss were assessed at 3, 6, and 12 months.

Results

After a median follow-up of 12 months (interquartile range (IQR) = 12–12) 31 new fractures were reported in 15 patients from the PV group and 28 new fractures in 19 patients from the sham group. The occurrence of new vertebral fractures did not significantly differ between the groups (χ2(1) = 0.83, p = 0.36, OR = .71, 95%CI = 0.33–1.50). There was no higher fracture risk of adjacent versus distant vertebrae. After sham procedure, further height loss of treated vertebrae occurred more frequently (7 patients (8%) in the PV group and 39 (45%) in the sham group (χ2(1) = 28.85, p < 0.001, OR = 9.84, 95%CI = 4.08–23.73)) and was more severe (p < .001) than after PV.

Conclusions

The risk of further vertebral height loss is significantly lower after PV compared to a sham intervention, i.e. PV protects against progressive vertebral height loss. In addition, PV does not increase the risk of new adjacent and distant OVCFs.

Level of Evidence

Level 1a, therapeutic study.
ClinicalTrials.gov number, NCT01200277
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Metadata
Title
Percutaneous Vertebroplasty is no Risk Factor for New Vertebral Fractures and Protects Against Further Height Loss (VERTOS IV)
Authors
Cristina E. Firanescu
Jolanda de Vries
Paul Lodder
Marinus C. Schoemaker
Albert J. Smeets
Esther Donga
Job R. Juttmann
Caroline A. H. Klazen
Otto E. H. Elgersma
Frits H. Jansen
Irene van der Horst
Marion Blonk
Alexander Venmans
Paul N. M. Lohle
Publication date
01-07-2019
Publisher
Springer US
Keyword
Osteonecrosis
Published in
CardioVascular and Interventional Radiology / Issue 7/2019
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-019-02205-w

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