The first percutaneous injection of bone cement into the spine was performed in 1984 to treat a 54 year old woman with extreme pain caused by a haemangioma in the second cervical vertebra. Surprisingly, pain relief was complete.1 After the case was published, indications for percutaneous vertebroplasty quickly expanded to include treatment of chronic back pain caused by metastases and osteoporotic fracture.

Since then, many case series have indicated that vertebroplasty is an effective way to control the pain of vertebral compression fracture caused by osteoporosis. The immediate relief of pain is often dramatic and, especially for the chronically debilitated patient, it may seem miraculous. The results are fairly consistent, and in one large case series of 552 patients, improvement in pain and disability persisted throughout two years of follow-up.2 Unfortunately, in the only published randomised controlled trial of vertebroplasty, almost all patients in the control group—who received conservative care—crossed over to the intervention group two weeks after randomisation, so the results were difficult to interpret.3 …