Vertebroplasty versus conservative treatment for vertebral fractures

One of the greatest concerns to be elucidated in the field of vertebral fractures is the proper definition of conservative management. In Caroline Klazen and colleagues' Vertos II study,1 “conservative therapy mainly consists of optimal pain medication. The internist optimises the use of analgesics. All patients receive osteoporosis medication, such as bisphosphonates together with supplemental calcium and vitamin D”. In the original protocol,2 however, Klazen and colleagues state that “conservative therapy, bed rest, pain medication, physiotherapy and bracing, is considered the standard care in patients with symptomatic osteoporotic vertebral compression fracture”. The main limitation of the present investigation is that Klazen and colleagues did not use braces for the management of these patients. Also it is not clear whether the patients underwent physiotherapy and bed rest. Braces are used in patients with vertebral fractures to reduce pain by decreasing postural flexion that causes increased load on the painful fractured vertebra and by helping to relieve paraspinal muscle spasm.3 Braces can help to reduce motion of the fractured vertebra, facilitating bone healing.3 Traditionally, three-point contact braces facilitate thoracic and lumbar neutral positioning while decreasing flexion.3 Unfortunately, although guidelines are available for the invasive techniques of cementoplasty, the best conservative treatment for patients with vertebral fractures has not yet been established. Until safe and effective conservative management is standardised, all studies on the topic will have enormous limitations.