We thank our colleagues for their critical comments and wish to point out once again that the main part of the section on material and methods had to be placed into the online version of the article, for reasons of space. The exact approach, including inclusion criteria, is detailed there. On this background, questions or misunderstandings may have arisen. We wish to respond to Rabenstein that, consistent with the guideline, unsuccessful conservative treatment for vertebral fracture was the prerequisite for undertaking vertebroplasty. Only conservative “treatment failures” were therefore included. It goes without saying that conservative treatment may also produce a successful outcome. However, the Vertos II study (a prospective, randomized, multicenter study) impressively confirmed the superiority of the intervention compared with the study arm that received conservative treatment (1). The cited study by Wang et al concludes that pain reduction, improved mobility, and reduced need for painkillers in the vertebroplasty group were better than in the conservative study arm (2). It seems important to mention in this context that the usually notable pain reduction sets in immediately after vertebroplasty and that the effect is long lasting. Regarding the studies by Buchbinder and Kallmes (3, 4), it deserves mention that many renowned working groups have published well-founded critiques. With this in mind, the uncritical rejection of vertebroplasty is scientifically not acceptable on the basis of these two publications alone; discussing the limitations of the procedure is scientifically vitally necessary.
Thomasius mentions the S3 guideline of the DVO in its updated version of 2009. In the section on the method of vertebroplasty and kyphoplasty and the resulting recommendations, the guideline is based mainly on the studies reported by Kallmes and Buchbinder. Developments in the past two years, however, provide ample reason to critically evaluate the method within the total therapeutic concept of osteoporotic vertebral compression fracture. The strict selection of suitable patients was not done retrospectively, with the benefit of hindsight, but was a prerequisite for participation, on the basis of the predefined selection criteria mentioned earlier. Each case represented a failure of conservative treatment; degenerative causes of pain had been excluded by clinical colleagues and team discussion of individual cases before anyone was allowed to participate. This was the obvious condicio sine qua non for the interventions that were conducted in this study exclusively radiologically; the underlying morbidity was treated by the referring physicians.
In conclusion, we think that vertebroplasty is a piece in the mosaic that is the total therapeutic concept. If the indication is consistent with the guidelines and is undertaken by an experienced specialist it provides a clinically valuable contribution accompanied by low risk, just as we showed in more than 1000 patients.
Dr. med. Anastasios Mpotsaris
Klinikum Vest, Knappschaftskrankenhaus Recklinghausen
Dr. med. Svenja Hennigs
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Klazen CA, Lohle PN, de Vries J, et al.: Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (vertos ii): An open-label randomised trial. Lancet 2010; 376(9746): 1085–92. CrossRef MEDLINE|
|2.||Wang HK, Lu K, Liang CL, et al.: Comparing clinical outcomes following percutaneous vertebroplasty with conservative therapy for acute osteoporotic vertebral compression fractures. Pain Med 2010; 11(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(6): 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(6): 569–79. CrossRef MEDLINE|
|5.||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|