Vertebroplasty is a fancy name for making a small cut in someone’s back then injecting bone glue (cement) into a vertebrae that has been damaged. It is used to treat the growing number of people with back pain: in 2003 25,000 Americans had vertebroplasty procedures, and the number is now closer to 100,000. They cost $5000 each. So between 125 and 375 million dollars are spent on vertebroplasty every year, just in the US.
The crazy thing is that real vertebroplasty is no better than fake (placebo) vertebroplasty. Researchers from Australia took 78 patients with spinal fractures of the kind that are often treated by vertebroplasty. Half of them the real thing while the other half got placebo vertebroplasty, where surgeons cut the skin and touched the bone to simulate the glue injection, but did not inject any cement.
Patients who received the fake procedure did as well as patients who received the real procedure. In some ways the real procedure was worse because patients who had the ‘real’ procedure were more likely to need drugs. To add salt to the wound, the cement glue used can leak, possibly causing more fractures, trouble controlling urination, and weakness in the legs.
I have no idea exactly how placebo vertebroplasty works, and neither do the people who conducted the study. My best guess is that when the surgeons cut the skin, the body senses trauma and launches a supercharged immune and anti-inflammatory response that cures the pain. One day scientists will figure out the reason, but in the meantime we know that the fake vertebroplasty works because of some sort of placebo effect, and that most people with back pain would be better off with something less invasive and harmful like mild exercise.
The fact that fake vertebroplasty is as good as the real thing doesn’t mean you should ask for a placebo if you get in a serious car accident or fall off a cliff and break your back. In those cases you clearly need the emergency room, and thank God for emergency rooms. But the vast majority of back pain is not so traumatic and doesn’t require surgery.
The fact that fake vertebroplasty is as good as the real thing also doesn’t mean that I have no sympathy for your back pain. I do. I retired from competitive rowing because of back pain. It got to the point where I couldn’t even stand up straight after practice. Competitive athletes are trained to “suck up”, so I carried on rowing for over a year while the pain was severe. Eventually it got so bad that I couldn’t stand up straight so I went to see a surgeon who ordered some scans that showed various abnormalities in my spine. Like all rowers my back was completely asymmetrical so I had scoliosis and apparently there wasn’t enough space for my spinal column in my lower spine to contain the spinal column. That’s what the head surgeon who did the scans said. He also offered a surgical procedure that would leave me in a hospital bed for 6 months and a 10% chance of paralysis.
I didn’t like the idea of surgery that might paralyze me, and it was time to get a job anyway, so I retired from competitiv rowing instead and took up Yoga to help cure my back. More gentle types of Yoga and exercise have been proven in systematic reviews to be very effective for healing back pain. It cured mine and I still race from time to time – that picture is of me racing a few months ago.
Almost all of you will have back pain at some point in your life, and unless you really do need the emergency room, it is probably best to avoid surgery and glue.