The vertebroplasty affair: the mysterious case of the disappearing effect size

The vertebroplasty affair: the mysterious case of the disappearing effect size Looking back Watson, it may have seemed too good to be true. There were the usual clues.</P>For instance, in 1997, an early report on the treatment of 47 osteoporotic compression fractures with the new vertebroplasty technique [1] found that patients who had severe pain did well, incredibly well. In fact, 90% had pain relief within 24 hours. In short order, another group reported “ complete pain relief” in 78% of patients with osteoporotic compression fractures treated with vertebroplasty [2] . Not to be outdone, a third group in 1998 reported “immediate … complete relief of symptoms” in 90% of 80 patients with osteoporosis treated with vertebroplasty [3] . Onward and upward, an arms race for more and more fantastic results, no control groups need apply.</P>Within a short period of time, vertebroplasty for osteoporotic compression fractures had become extremely common. Podium presentations, including those at North American Spine Society (NASS)'s annual meeting, sometimes described thousands of vertebroplasties performed; comically good results were confidently proclaimed amid a stroboscopic flashing of radiographs depicting expertly placed cement; brief, blurred slides causally confirmed complications so rare that venipuncture seemed more hazardous. Impressive case series abounded. Superior outcomes were claimed to last for 6 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Spine Journal Elsevier

The vertebroplasty affair: the mysterious case of the disappearing effect size

The Spine Journal, Volume 10 (3) – Mar 1, 2010

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Publisher
Elsevier
Copyright
Copyright © 2010 Elsevier Inc.
ISSN
1529-9430
DOI
10.1016/j.spinee.2010.01.002
Publisher site
See Article on Publisher Site

Abstract

Looking back Watson, it may have seemed too good to be true. There were the usual clues.</P>For instance, in 1997, an early report on the treatment of 47 osteoporotic compression fractures with the new vertebroplasty technique [1] found that patients who had severe pain did well, incredibly well. In fact, 90% had pain relief within 24 hours. In short order, another group reported “ complete pain relief” in 78% of patients with osteoporotic compression fractures treated with vertebroplasty [2] . Not to be outdone, a third group in 1998 reported “immediate … complete relief of symptoms” in 90% of 80 patients with osteoporosis treated with vertebroplasty [3] . Onward and upward, an arms race for more and more fantastic results, no control groups need apply.</P>Within a short period of time, vertebroplasty for osteoporotic compression fractures had become extremely common. Podium presentations, including those at North American Spine Society (NASS)'s annual meeting, sometimes described thousands of vertebroplasties performed; comically good results were confidently proclaimed amid a stroboscopic flashing of radiographs depicting expertly placed cement; brief, blurred slides causally confirmed complications so rare that venipuncture seemed more hazardous. Impressive case series abounded. Superior outcomes were claimed to last for 6

Journal

The Spine JournalElsevier

Published: Mar 1, 2010

References

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