I read the article by Mpotsaris et al with interest, hoping to gain an understanding of the effectiveness of the increasingly widely used percutaneous vertebroplasty (1). Table 1, showing the patients’ pre-interventional status, seemed informative and well structured. But what followed was a disappointment and unsatisfactory from a clinical as well as a scientific perspective. The result tables show only P values. Not a single symptom was quantified or qualified according to the original table. Since no control group with conservative treatment had been evaluated in the study, readers do not learn whether any advantage exists for the intervention. In many patients receiving conservative treatment for osteoporosis and vertebral fractures, at least pain and mobility improve within one to three months. A current study with a comparison group showed exactly the same P values for symptom improvement in both therapeutic arms (2).
Instead, the discussion dismantles the “negative” results of two high ranking, published, prospective randomized studies by using questionable arguments (3, 4); both studies had at least attempted to make a genuine comparison by means of elaborate sham procedures . In terms of the popularity, reputation, and visibility of Deutsches Ärzteblatt International, I would have wished for a more objective and understandable presentation of the topic. Maybe a critical editorial would have been helpful, too.
Prof. Dr. med. Thomas Rabenstein
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Mpotsaris A, Abdolvahabi R, Hoffleith B, et al.: Percutaneous vertebroplasty in vertebral compression fractures of benign or malignant origin: a prospective study of 1188 patients with follow-up of 12 months. Dtsch Arztebl Int 2011; 108(19): 331–8. VOLLTEXT|
|2.||Wang HK, Lu K, Liang CL, Weng HC, Wang KW, Tsai YD, Hsieh CH, Liliang PC. Comparing clinical outcomes following percutaneous vertebroplasty with conservative therapy for acute osteoporotic vertebral compression fractures. Pain Med 2010; 11: 1659–65. CrossRef MEDLINE|
|3.||Buchbinder R, Osborne RH, Ebeling PR, et al.: A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. New Engl J Med 2009; 361: 557–68. CrossRef MEDLINE|
|4.||Kallmes DF, Comstock BA, Heagerty PJ, et al.: A randomized trial of vertebroplasty for osteoporotic spinal fractures. New Engl J Med 2009; 361: 569–79. CrossRef MEDLINE|