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Vertebral Compression FracturesVITTANCT02370628

Vertebroplasty In The Treatment Of Acute Fracture Trial - The VITTA Trial

A study testing Percutaneous vertebroplasty and Facet block in people with Vertebral Compression Fractures, run by Centre hospitalier de l'Université de Montréal (CHUM) at 1 site in Canada.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The VITTA trial is a randomized, controlled, single-blinded, cross-over trial comparing percutaneous vertebroplasty with facet block in patients with acute (<1month) and painful vertebral compression fractures. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Vertebral Compression Fractures
What is being tested?
Percutaneous vertebroplasty and Facet block
Could I receive a placebo?
No, everyone receives an active treatment
How many people
2 participants
Where
1 siteCanada
Study dates
17 Apr 2015to 5 Jun 2018
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age > 18 years
  • Presence of:
  • at least one and at most two acute VCF (< 6 weeks) at levels caudate to T4, confirmed with physical examination and radiographic imaging
  • if timing of the fracture is unclear, the following criteria are required for inclusion in the trial
  • an MRI scan showing edema at the fracture level(s) or
  • a bone scan showing increased uptake
  • Physical examination showing axial back pain likely secondary to the VCF with restricted mobilization (score not maximum on any one of the following Barthel's Index items: transfer, mobility, bathing, dressing, stairs and toilet use)
  • French or English speaking patient willing to return for follow-up or capable of following up with phone interviews if needed

Who cannot join

  • Recent (<30 days) major surgery causing debilitating pain
  • Coagulopathy or thrombocytopenia precluding interventional treatment
  • Inability to provide informed consent

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • Centre hospitalier de l'Université de Montréal (CHUM)

    Montreal, Quebec, H2L 4M1

Other trials in Canada

About this study

Official title: Vertebroplasty In The Treatment Of Acute Fracture Trial (The VITTA Trial)

The VITTA trial is a randomized, controlled, single-blinded, cross-over trial comparing percutaneous vertebroplasty with facet block in patients with acute (<1month) and painful vertebral compression fractures.

The treatment offered for vertebral compression fractures (VCFs) in the interventional arm of the trial is vertebroplasty, which will be performed in accordance with the standardized protocol of the Canadian Association of Radiologists. Patients in the control arm will receive facet block, where a long-acting local anesthetic agent and corticosteroids are injected in the spinal articular facets at the affected level.

Read the detailed description

Vertebroplasty is a procedure used to stabilize broken vertebrae, the bones that form the spine. This study will evaluate the effectiveness of vertebroplasty for the treatment of acute vertebral fractures.

The VITTA trial is a randomized, controlled, single-blinded, cross-over trial comparing percutaneous vertebroplasty with facet block in patients with acute (<1 month) and painful vertebral compression fractures.

Vertebral compression fractures (VCFs) frequently result in debilitating pain, impaired functional status and bad quality of life. Percutaneous vertebroplasty (PV) is a treatment for VCFs originally developed in France in the late 1980s and first performed in America in the mid-1990s. The procedure involves percutaneous application of bone cement (polymethylmethacrylate) into collapsed vertebrae.

VCFs are a significant public health problem with approximately 750,000 new fractures occurring in the United States each year, a number that is projected to rise as the population ages. In fact, one quarter of adults over the age of 50 will suffer at least one VCF in their lifetime. VCFs cause short term and occasionally long-term pain and disability, and although not immediately life threatening, they are associated with long term mortality. Before the advent of PV, the treatment for VCFs was limited to medical therapy- addressing the pain associated with the fracture but not the fracture itself thus making VCFs practically the only skeletal fracture not treated with orthopedic surgery. Since the introduction of vertebroplasty, over 800 papers, technical notes, and reviews that address this technique have been published with the overwhelming majority reporting significant pain relief and advocating the adoption of the procedure into common practice. Unfortunately, most of these studies had low evidence level and poor scientific design until randomized clinical trials were published in 2009.

Vertebroplasty for refractory back pain (after a period of conservative management of 1 month) constituted the main indication in the overwhelming majority of studies published so far. Although those studies have largely suggested that it does not offer significant improvement in pain or functional status relative to medical therapy or infusion of local anesthesia after this acute phase, the data remains inconclusive and of poor scientific quality. The present study proposes a different rationale: the benefits of vertebroplasty may be occurring in the acute phase (before 1 month) by providing immediate pain relief to the patient, hence allowing early mobilization and preventing medical complications associated with bed rest. In other terms, vertebroplasty may be a first line, acute phase treatment. If the investigators hypothesis holds true, an adequately powered clinical trial may provide sufficient evidence to change the medical indications for vertebroplasty.

Being tested
Percutaneous vertebroplasty, Facet block
Keywords
percutaneous vertebroplasty, facet block

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Percutaneous vertebroplastyProcedure or surgery

    The procedure involves percutaneous application of bone cement (polymethylmethacrylate) into collapsed vertebrae, and has been used for treatment of patients with osteoporosis who have severe or prolonged pain following vertebral compression fracture, as well as those with painful, aggressive hemangiomas and osteolytic neoplasms.

    In our trial, vertebroplasty shall be performed in two steps:

    • Step 1: facet block
    • Step 2: cement infusion

    Therefore, patients in both arms will undergo Step 1 since our control intervention serves as a routine first part of our active intervention.

  • Facet blockProcedure or surgery

    A long-acting local anesthetic agent and corticosteroids are injected in the spinal articular facets at the affected level.

    All patients will undergo facet block since it serves as a routine first part to percutaneous vertebroplasty.

Study groups in NCT02370628
Study groupRoleWhat they receive
Percutaneous vertebroplasty (PV)ExperimentalThe procedure involves percutaneous application of bone cement (polymethylmethacrylate) into collapsed vertebrae.
Receives: Procedure: Percutaneous vertebroplasty; Procedure: Facet block
Facet blockActive comparatorinjection of anti-inflammatory and analgesic drugs
Receives: Procedure: Facet block

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Achieving a score of 75 or higher on the Barthel Index functional evaluation score

    Measured: 30 days after treatment

Secondary outcomes (3)
  1. Rate of cross-over to the alternative treatment

    Measured: 15 days after treatment

  2. Level of pain as measured by the visual analogue pain scale

    Measured: at 15 days and 30 days

  3. Proportion of patients located at home

    Measured: 15 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Feb 2015 (estimated)
  2. Study start17 Apr 2015
  3. Primary completion5 Jun 2018
  4. Study completion5 Jun 2018

Why it stopped: too few participants enrolled and few interested patients in three years

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
2 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02370628
Sponsor's protocol ID
CE14.334
Acronym
VITTA
Status last verified
Jun 2018
First submitted
9 Feb 2015
Last updated
14 Jun 2018
Results posted
No
Data monitoring committee
Yes

Publications

  • Bourgoin P, Weill A, Tampieri D. CAR Standard for Performance of the Percutaneous Vertebroplasty. Can Assoc Radiol. 2002;(March).

  • Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009 Aug 6;361(6):569-79. doi: 10.1056/NEJMoa0900563.

    PubMed 19657122
  • Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009 Aug 6;361(6):557-68. doi: 10.1056/NEJMoa0900429.

    PubMed 19657121
  • Comstock BA, Sitlani CM, Jarvik JG, Heagerty PJ, Turner JA, Kallmes DF. Investigational vertebroplasty safety and efficacy trial (INVEST): patient-reported outcomes through 1 year. Radiology. 2013 Oct;269(1):224-31. doi: 10.1148/radiol.13120821. Epub 2013 May 21.

    PubMed 23696683
  • Voormolen MH, Mali WP, Lohle PN, Fransen H, Lampmann LE, van der Graaf Y, Juttmann JR, Jansssens X, Verhaar HJ. Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol. 2007 Mar;28(3):555-60.

    PubMed 17353335
  • Do HM, Kim BS, Marcellus ML, Curtis L, Marks MP. Prospective analysis of clinical outcomes after percutaneous vertebroplasty for painful osteoporotic vertebral body fractures. AJNR Am J Neuroradiol. 2005 Aug;26(7):1623-8.

    PubMed 16091504
  • Deramond H, Darrason R GP. Percutaneous vertebroplasty with acrylic cement in the treatment of aggressive spinal angiomas. Rachis. 1989;1(2):143-53.

  • Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol. 1997 Nov-Dec;18(10):1897-904.

    PubMed 9403451
  • Deramond H, Depriester C, Galibert P, Le Gars D. Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am. 1998 May;36(3):533-46. doi: 10.1016/s0033-8389(05)70042-7.

    PubMed 9597071
  • Gangi A, Guth S, Imbert JP, Marin H, Dietemann JL. Percutaneous vertebroplasty: indications, technique, and results. Radiographics. 2003 Mar-Apr;23(2):e10. doi: 10.1148/rg.e10.

    PubMed 12889460
  • Gu YF, Li YD, Wu CG, Sun ZK, He CJ. Safety and efficacy of percutaneous vertebroplasty and interventional tumor removal for metastatic spinal tumors and malignant vertebral compression fractures. AJR Am J Roentgenol. 2014 Mar;202(3):W298-305. doi: 10.2214/AJR.12.10497.

    PubMed 24555629
  • Chen G, Luo ZP, Zhang H, Nalajala B, Yang H. Percutaneous kyphoplasty in the treatment of painful osteoblastic metastatic spinal lesions. J Clin Neurosci. 2013 Jul;20(7):948-50. doi: 10.1016/j.jocn.2012.08.010. Epub 2013 May 3.

    PubMed 23647710
  • Pereira LP, Clarencon F, Cormier E, Rose M, Jean B, Le Jean L, Chiras J. Safety and effectiveness of percutaneous sacroplasty: a single-centre experience in 58 consecutive patients with tumours or osteoporotic insufficient fractures treated under fluoroscopic guidance. Eur Radiol. 2013 Oct;23(10):2764-72. doi: 10.1007/s00330-013-2881-3. Epub 2013 May 21.

    PubMed 23689309
  • Weill A, Chiras J, Simon JM, Rose M, Sola-Martinez T, Enkaoua E. Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology. 1996 Apr;199(1):241-7. doi: 10.1148/radiology.199.1.8633152.

    PubMed 8633152
  • Chiras J, Depriester C, Weill A, Sola-Martinez MT, Deramond H. [Percutaneous vertebral surgery. Technics and indications]. J Neuroradiol. 1997 Jun;24(1):45-59. French.

    PubMed 9303944

Questions about this trial

What is this clinical trial studying?

A study testing Percutaneous vertebroplasty and Facet block in people with Vertebral Compression Fractures, run by Centre hospitalier de l'Université de Montréal (CHUM) at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 14 Jun 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study was stopped early (reason given: too few participants enrolled and few interested patients in three years). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Achieving a score of 75 or higher on the Barthel Index functional evaluation score (time frame: 30 days after treatment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02370628, which also lists 27 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Jun 2018.

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