Vertebroplasty includes the percutaneous insertion of a needle through the pedicles into the vertebral body and the injection of a bone cement (PMMA or CaP) into the cancellous bone [171]. The cement will follow the path of least resistance and the procedure is monitored directly under fluoroscopic control. For balloon kyphoplasty, cannulae placed percutaneously into the vertebral body permit the insertion of two inflatable bone tamps (IBTs) [172]. After removal of the IBTs, the pre-defined cavity is filled with PMMA- or CaP [173] under low manual pressure [174]. Like during vertebroplasty, the procedure is monitored directly under fluoroscopy. Besides stabilizing

the fracture, balloon kyphoplasty also aims QNZ at restoring vertebral body anatomy with height recovery and angular deformity correction [175]. A thorough discussion of both techniques is beyond the scope of this article, as a systematic in-depth review on PF-3084014 the topic by a dedicated IOF Working Group has been submitted for publication (S. Boonen, personal communication). While a number of randomized controlled studies have demonstrated acute advantage of vertebroplasty over medical treatment in pain relief of VCFs [176, 177], these findings have been questioned by recent sham-controlled

randomized clinical studies that could not confirm these conclusions [178, 179], with no significant between-group differences regarding pain HDAC inhibitors cancer reduction , quality of life or physical functioning. In the first of these trials, 78 patients with one or two

painful osteoporotic fractures were randomized to undergo VP or a simulated sham Ribonuclease T1 procedure [178]. The primary outcome was overall pain score at 3 months, which decreased in both groups significantly compared with baseline. Pain reduction was sustained in both groups for 6 months. Similar improvements were seen in both groups with respect to physical function, quality of life, and perceived improvement in pain, even after adjustment for baseline levels of previous vertebral fractures and duration of symptoms. In the second single-blind trial, 131 patients were randomly assigned to VP or a simulated sham procedure [179]. The primary endpoints of the study were scores in the modified Roland Morris Disability Questionnaire and perceived back pain intensity after 1 month. Both procedures had an immediate and sustained improvement up to 1 month after the intervention, although not statistically different between the two arms. The improvements of other measures of pain, physical function and quality of life (EQ-5D, SF-36 MCS, and PCS) did not also differ between groups at 1 month. Unfortunately, cross-over of patients in this study precluded longer term randomized comparisons between groups. Nevertheless, both studies have questioned the value of vertebroplasty.