nyt - Gina Kolata. New York Times. (Late Edition (East...

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Gina Kolata. New York Times. (Late Edition (East Coast)). New York, N.Y.: Aug 28, 2005. pg. 1.1 Abstract (Document Summary) In 2002, he reported his results: three patients initially had vertebroplasty and two had the sham. But there was no difference in pain relief. All the patients thought they had gotten the placebo, and all wanted the other treatment after 10 days. One patient who had vertebroplasty followed in 10 days by the sham said the second procedure -- the sham -- relieved his pain. Some small studies have found a suggestion of high fracture rates in vertebrae adjacent to those injected with cement. And Dr. [Mary Bouxsein] and others, testing spines from cadavers, found they fractured more easily if one of the vertebrae was filled with cement. ''It's a tough issue,'' Dr. Bouxsein said. If a patient gets profound and immediate pain relief, that alone may make the procedure worthwhile, she said. Or, then again, it may not. An osteoporosis patient, Stanley Stanton, a 58-year-old foreman in Owatonna, Minn., broke vertebrae by simply twisting his torso one day this spring. The pain was so bad that he could hardly walk. But after vertebroplasty, he said, ''I walked out of there two hours later and I was 300 percent better.'' That was in June; today he needs only an occasional over-the-counter pain reliever. Full Text (1976 words) Copyright New York Times Company Aug 28, 2005 It used to be that a patient with osteoporosis who broke a vertebra was pretty much out of luck. The only recourse was wearing a back brace and waiting to heal. If the searing pain was unbearable, it could be blunted with powerful narcotics. But in the past few years, doctors have been offering and patients demanding what some call a miraculous treatment: vertebroplasty (pronounced vur-TEE-bro-plasty), in which a form of cement is injected into the broken spinal bone. No one is sure why it helps, or even if it does. The hot cement may be shoring up the spine or merely destroying the nerve endings that transmit pain. Or the procedure may simply have a placebo effect. And some research hints that the procedure may be harmful in the long run, because when one vertebra is shored up, adjacent ones may be more likely to break. But vertebroplasty and a similar procedure, kyphoplasty, are fast becoming the treatments of choice for patients with bones so weak their vertebrae break. The two procedures are so common, said Dr. Ethel Siris, an osteoporosis researcher at Columbia University, that ''if you have osteoporosis and come into an emergency room with back pain from a fractured vertebra, you are unlikely to leave without it.'' She said she was concerned about the procedures' widespread and largely uncritical acceptance.
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In three years, the number of vertebroplasties nearly doubled, to more than 27,000 in 2004 from 14,000 in 2001. Despite the lack of rigorous evidence that the procedures work, most were covered by Medicare, at a cost of $21 million last year. (There is even less data on the effects of
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nyt - Gina Kolata. New York Times. (Late Edition (East...

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