Reviewer's comment concerning 'Continuing conservative care versus cross-over to radiofrequency kyphoplasty: a comparative effectiveness study on the treatment of vertebral body fractures' (doi:10.1007/s00586-012-2148-8 by R. Bornemann, M. Hanna, K. Kabir, H. Goost, D. C. Wirtz, R. Pflugmacher).

摘要

Osteoporotic vertebral fractures are very frequent, and management of such fractures is controversial. Two randomized controlled trials concluded that an augmentation technique, percutaneous vertebroplasty with PMMA, was no better than placebo. However, two subsequent controlled randomized trials found that a different augmentation procedure, kyphoplasty, was beneficial for treating these fractures.In this report, the authors present a double cohort clinical study in which patients selected treatment based on pain and functional impairment. A study like this is probably as relevant as a clinical trial for evaluating a surgical technique. The results demonstrated that vertebral augmentation with PMMA relieved pain and improved function much faster than conservative treatment. We observed similar results in a similar study of vertebroplasty [1]. In our study, however, the pain and functional results were similar in both groups of patients at the one-year follow-up.One interesting finding in this study is that the authors did address progression of the deformity after 6 weeks in patients who opted for conservative treatment. However, we do not know the clinical results of these patients after 1 year or whether loss of kyphosis had any clinical relevance.