What is the role of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral fractures?

Updated: Nov 12, 2019
  • Author: Gaurav Gupta, MD; Chief Editor: Justin A Siegal, MD  more...
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One of the most common complications of osteoporosis is vertebral fracture that can occur spontaneously or more frequently as a result of minor trauma. In the United States, the incidence of compression fractures is more than 500,000 patients per year with a 16% lifetime risk in women and 5% lifetime risk in men. [4]

These vertebral fractures are often highly painful and can lead to pain-limited immobility, which leads to demineralization and propagation of a vicious cycle of continued demineralization and increased predisposition to fracture. Although the initial symptoms tend to disappear in 4–6 weeks, in many cases some patients have severe, persistent, incapacitating pain despite medical therapy. Consequences of untreated fracture include reduced height, reduction of normal thoracic kyphosis, and chronic back pain.

An important consideration in the discussion of vertebroplasty is the VERTOS study, which directly compared vertebroplasty to medical management. The VERTOS study prospectively compared osteoporotic compression fracture treatment of 18 patients with vertebroplasty to 16 patients with optimal medical management and found improvement in pain relief for the vertebroplasty group. [7] These results were confirmed with the VERTOS II study, a larger prospective randomized trial consisting of 101 patients treated with vertebroplasty and 101 treated with conservative management). [8, 9]

Two important studies to consider are those by Buchbinder et al. and Kallmes et al., each of which compared vertebroplasty to sham procedures and importantly demonstrated no significant improvement with vertebroplasty. [10, 11] This mixed evidence has sparked considerable debate as to the appropriate role of this procedure.

The VERTOS IV study, a randomized control trial published in four community hospitals in the Netherlands, looked at 180 patients comparing vertebroplasty vs sham procedure and did not show any statistically significant greater pain relief than sham procedure during 12 month follow up in patients with osteoporotic compression fractures. [12]

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