A Trial of Vertebroplasty for Painful Chronic Osteoporotic Vertebral Fractures (Vertos V) (VERTOSV)

This study is currently recruiting participants. (see Contacts and Locations)
Verified October 2013 by St. Elisabeth Hospital, Tilburg, Netherlands
Sponsor:
Information provided by (Responsible Party):
St. Elisabeth Hospital, Tilburg, Netherlands
ClinicalTrials.gov Identifier:
NCT01963039
First received: August 28, 2013
Last updated: October 9, 2013
Last verified: October 2013
  Purpose

Background The standard care in patients with a painful osteoporotic vertebral compression fracture (VCF) is conservative therapy. Percutaneous vertebroplasty (PV), a minimally invasive technique, is a relatively new treatment option. Recent randomized controlled trials (RCT) provide conflicting results: two sham-controlled studies showed no benefit of PV while an unmasked but controlled RCT (VERTOS II) found effective pain relief at acceptable costs in patients with acute VCFs. A still ongoing masked RCT (VERTOS IV) focuses on acute VCFs defined as ≤ 6 weeks. VERTOS III focused on conservative treatment and found that half of patients still had disabling pain after 3 months or longer. These patients with sustained pain after 3 months may benefit from PV.

Objective To compare pain relief after PV with a sham intervention in selected patients with a chronic osteoporotic VCF ( three months or longer) using the same strict inclusion criteria as in VERTOS II an IV. Secondary outcome measures are back pain related disability and quality of life.

Methods The VERTOS V study is a prospective RCT with pain relief as primary endpoint. Inclusion criteria are a VCF of thoracic level 5 or lower with focal tenderness at fracture level, assessed by an internist on physical examination and a Visual Analogue Scale (VAS) score ≥ 5 for three months or longer, decreased bone density defined as T score ≤ -1 and age 50 years or older. 94 patients will be included, 47 in each arm. Crossovers are not allowed. Follow-up is at regular intervals during one year period with VAS score for pain as primary endpoint. Secondary endpoints are back pain related disability and quality of life measured with the Quality of Life Questionnaire of the European Foundation for Osteoporosis and physical function measured with the Roland Morris Disability questionnaire.

Conclusion Vertos V is a methodologically sound masked randomised sham controlled trial of vertebroplasty in patients with sustained pain 3 months or longer after a vertebral compression fracture.


Condition Intervention
Osteoporosis
Vertebral Fracture
Device: percutaneous vertebroplasty
Procedure: Sham procedure

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Subject)
Primary Purpose: Treatment
Official Title: A Randomised Sham Controlled Trial of Vertebroplasty for Painful Chronic Osteoporotic Vertebral Fractures

Resource links provided by NLM:


Further study details as provided by St. Elisabeth Hospital, Tilburg, Netherlands:

Primary Outcome Measures:
  • Pain relief [ Time Frame: 12 months ] [ Designated as safety issue: No ]
    Primary outcome will be pain score at 1 day, 1 week, and 1,3, 6 and 12 months after PV compared to baseline pain score. The questionnaire consist of the VAS score and questions about use of pain medication, pain location, and pain type. Other medical treatment and visits to alternative medical specialists, GP's and physical therapists are recorded and compared between groups. Patients are asked to fill out the VAS score and use of analgesics is recorded on a daily basis during the first month after randomization.


Secondary Outcome Measures:
  • Back pain related disability [ Time Frame: 0, 1day, 1 week, 1,3,6,12 months ] [ Designated as safety issue: No ]
    Back pain related disability as measured with the Roland Morris Disability (RMD) Questionnaire. The Qualeffo is developed specifically for patients with osteoporosis. This questionnaire consists of 41 questions about: pain, physical function, social function, general health perception, and mental function. The RMD questionnaire is a disability questionnaire that measures the functional status of patients with back pain.

  • Quality of Life [ Time Frame: 1 week, 1,3,6,12 months ] [ Designated as safety issue: No ]
    QOL as measured with the Questionnaire of the European Foundation for Osteoporosis (Qualeffo). The Qualeffo is developed specifically for patients with osteoporosis. This questionnaire consists of 41 questions about: pain, physical function, social function, general health perception, and mental function. The Qualeffo score ranges from 0 (best quality of life) to 100 (worst quality of life). This questionnaire will be completed at five measurement moments (before and at 1, 3, 6, and 12 months after the procedure).


Estimated Enrollment: 94
Study Start Date: May 2013
Estimated Study Completion Date: December 2014
Estimated Primary Completion Date: October 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: percutaneous vertebroplasty
Using fluoroscopic guidance, the practitioner infiltrates the skin and subcutaneous tissues overlying the pedicle of the target vertebra or vertebrae with 1% lidocaine and infiltrates the periosteum of the pedicles with 0.25% bupivacaine (marcaine). For the vertebroplasty procedure, 11-gauge or 13-gauge needles are passed into the central aspect of the target vertebra or vertebrae. Bone cement (PMMA) is prepared on the bench and injected under constant fluoroscopy into the vertebral body. Injection is stopped when the cement reaches to the posterior aspect of the vertebral body or leaks into an extraosseous space, such as the intervertebral disk or an epidural or paravertebral vein.
Device: percutaneous vertebroplasty
Using fluoroscopic guidance, the practitioner infiltrates the skin and subcutaneous tissues overlying the pedicle of the target vertebra or vertebrae with 1% lidocaine and infiltrates the periosteum of the pedicles with 0.25% bupivacaine (marcaine. For the vertebroplasty procedure, 11-gauge or 13-gauge needles are passed into the central aspect of the target vertebra or vertebrae. Bone cement is prepared on the bench and injected under constant fluoroscopy into the vertebral body. Injection is stopped when the PMMA reaches the posterior aspect of the vertebral body or leaks into an extraosseous space, such as the intervertebral disk or an epidural or paravertebral vein.
Other Name: § 888.302713 Polymethylmethacrylate (PMMA) Bone Cement.
Sham Comparator: Sham procedure
Using fluoroscopic guidance, the practitioner infiltrates the skin and subcutaneous tissues overlying the pedicle of the target vertebra or vertebrae with 1% lidocaine and infiltrates the periosteum of the pedicles with 0.25% bupivacaine (marcaine). During the sham intervention, verbal and physical cues, such as pressure on the patient's back, are given, and the bone cement(PMMA) is prepared to simulate the odor associated with mixing of polymethacrylate , but the needle is not placed and cement is not injected.
Procedure: Sham procedure
Using fluoroscopic guidance, the practitioner infiltrates the skin and subcutaneous tissues overlying the pedicle of the target vertebra or vertebrae with 1% lidocaine and infiltrates the periosteum of the pedicles with 0.25% bupivacaine (marcaine). During the sham intervention, verbal and physical cues, such as pressure on the patient's back, are given, and the methacrylate monomer (PMMA) is opened to simulate the odor associated with mixing of cement, but the needle is not placed and cement is not injected.

  Eligibility

Ages Eligible for Study:   50 Years to 95 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • VCF on X-ray of the spine (minimal 15% loss of height)
  • level of VCF Th5 or lower
  • back pain ≥ 12 weeks at time of X-ray
  • ≥ 50 years of age
  • bone edema on MRI of the fractured vertebral body
  • focal tenderness on VCF level
  • decreased bone density T-scores ≤ -1

Exclusion Criteria:

  • severe cardio-pulmonary condition
  • untreatable coagulopathy
  • systemic or local infection of the spine (osteomyelitis, spondylodiscitis)
  • suspected alternative underlying disease (malignancy)
  • radicular and/or cauda compression syndrome
  • contra-indication for MRI
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01963039

Locations
Netherlands
St. Elisabeth Ziekenhuis Recruiting
Tilburg, Netherlands, 5022 GC
Contact: Willem Jan Rooij, PhD    +313135391313    wjjvanrooij@gmail.com   
Principal Investigator: Dennis Carli, MD         
Sponsors and Collaborators
St. Elisabeth Hospital, Tilburg, Netherlands
Investigators
Principal Investigator: Dennis Carli, drs St. Elisabeth Hospital, Tilburg, Netherlands
Study Chair: Willem- Jan Rooij, Prof. dr. St. Elisabeth Hospital, Tilburg, Netherlands
Study Director: Paul Lohle, dr. St. Elisabeth Hospital, Tilburg, Netherlands
  More Information

No publications provided

Responsible Party: St. Elisabeth Hospital, Tilburg, Netherlands
ClinicalTrials.gov Identifier: NCT01963039     History of Changes
Other Study ID Numbers: EZTilburg2
Study First Received: August 28, 2013
Last Updated: October 9, 2013
Health Authority: Netherlands: The Central Committee on Research Involving Human Subjects (CCMO)

Additional relevant MeSH terms:
Back Injuries
Osteoporosis
Fractures, Bone
Spinal Fractures
Bone Diseases, Metabolic
Bone Diseases
Musculoskeletal Diseases
Wounds and Injuries
Spinal Injuries
Polymethyl Methacrylate
Vasodilator Agents
Cardiovascular Agents
Therapeutic Uses
Pharmacologic Actions
Antimutagenic Agents
Protective Agents
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on September 16, 2014