I read with great interest the original article by Saracen and Kotwica [1] entitled "Treatment of multiple osteoporotic vertebral compression fractures by percutaneous cement augmentation" published recently in your most valuable journal. In this article, the authors concluded that vertebroplasty should be seriously taken into account as a primary method of treatment in patients with multiple osteoporotic vertebral compression fractures. I have many questions concerning the procedure: 1. The authors augment only two vertebrae but never two adjacent ones. The first procedures were performed in the most painful areas. A total of 146 patients had three or more fractured vertebrae; thus how do the authors decide which are the painful vertebrae? According to the clinical or radiological examination? Radiologically, the most compressed one may not be painful. It may be healed with fibrosis. I believe the indication for percutaneous vertebroplasty and decision-making for the exact number of levels to be cemented is biased by being subjected to individual surgeon's preference instead of an underlying standardized study protocol for diagnostic screening and surgical indication.
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