AAOS Clinical Guideline for Treating Spinal Compression Fractures Presents More Questions Than Answers for Medical Community
WASHINGTON, Nov. 9, 2010 /PRNewswire/ -- The clinical practice guideline recently issued by the American Academy of Orthopaedic Surgeons (AAOS) for treating spinal compression fractures has left the medical community scratching its head about what to tell patients. Spinal compression fractures (also called vertebral compression fractures or VCFS) are the most common complication of osteoporosis, a disease that affects an estimated 44 million Americans, or 55 percent of adults age 50 and older. Approximately 700,000 new VCFs occur annually. They cause intractable pain and are a source of increased morbidity.
Of the 11 recommendations made by AAOS, more than half are rated as "inconclusive." According to AAOS, evidence quality was critical in supporting the practice guidelines and it didn't find enough high-quality evidence to support or oppose most non-surgical treatments, including traditional treatment options such as bed rest, analgesics, bracing, and physical therapy.
AAOS made only one "strong" recommendation. It was against the use of vertebroplasty, a minimally invasive procedure that involves injecting bone cement into the fracture to
stabilize and strengthen the vertebra. The group based its recommendation on the results of two studies published in the New England Journal of Medicine (NEJM). The studies compared vertebroplasty against a placebo procedure and found no statistically significant difference between the two.
But did the studies exhibit enough clinically efficiency to justify that recommendation? "No," says Dr. Wayne Olan, MD, Director of Interventional and Endovascular Neurosurgery at George Washington University Medical Faculty Associates in Washington, DC, and a consulting physician for neuroradiology at the National Institutes of Health in Bethesda, Md.
"The NEJM studies don't come close to the standards AAOS