We are in a dilemma here. My three sisters and I have been asked to approve surgery for Dad. He needs a vertebroplasty for a fractured vertebra. The problem is we will probably end up having to split the noncovered costs as Dad has no money. We’ve been told he could get better without surgery. It just takes longer and hurts more. We don’t want him to suffer but to be honest, at age 86, we’re not sure how long he’ll live anyway. That sounds pretty blunt but that’s what we are dealing with. Can you give us any information that could help us?

What you are asking for is a cost versus benefit analysis of a vertebroplasty for your father. That is a very reasonable request and one that you can ask the surgeon to help you with. What we can tell you from the evidence presented in studies so far is that for patients with painful vertebral compression fractures caused by osteoporosis, there is no long-term advantage of having a vertebroplasty procedure over conservative (nonoperative) care.

The vertebroplasty involves placing a needle into the fractured vertebra and injecting cement into it to stabilize the bone and keep it from further damage. When patients were treated with vertebroplasty and compared to those treated conservatively, the pain levels, level of function, and/or disability between the two groups was the same three months later.

However, the vertebroplasty procedure does offer faster pain relief in the early days of the fracture. That could be an important deciding factor for some patients. Some patients, families, and surgeons together decide to try the conservative approach for at least six weeks and see how much improvement occurs. If there is fair-to-good (or better) improvement, then the nonoperative treatment can be extended for as much as six-months before considering something else.