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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 10.5144/0256-4947.2008.306aasm-4-306aLettersReply Al-Nakshabandi Nizar Department of Radiology, King Khalid University Hospital, Riyadh, Saudi Arabia, nizar97@hotmail.comJul-Aug 2008 28 4 306 307 Copyright © 2008, Annals of Saudi Medicine2008This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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In response to Dr. Sadat-Ali, the comment, the “lack of well established pain management protocols” was the conclusion of Kaemmerlen et al in the New England Journal of Medicine,1 and is not my assertion. The indications for vertebroplasty in general and in our patients were mentioned and include pain relief, stabilization, destructive metastases, extensive bone lysis in multiple myeloma, and weakened vertebra in the vertebral body.2 Although failure of conservative therapy is an indication for vertebroplasty in chronic back pain secondary to osteoporotic fractures, there is growing evidence that the use of this procedure in the acute setting is more beneficial.3–5 The focus of this study was not to shed light on osteoporosis, which has been done many times, even by Dr. Sadat-Ali himself, but rather to shed light on a solution to a problem of great magnitude in the region.

Finally I am surprised at Dr. Sadat-Ali’s comment that “the procedure needs to be done at regional centers where such procedures are done on a regular basis”. The author received training and board certification, including a hands-on fellowship in image-guided musculoskeletal interventions. The procedure is done on regular basis with a team approach and has been widely accepted by referring physicians and patients alike.
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REFERENCES
1 Kaemmerlen P  Thiesse P  Jonas P  Berard CL  Duquesnel J  Bascoulergue Y  Lapras C   Percutanneous Injection of Orthopedic Cement in Metastatiic Vertebral Lesions N Engl J Med 13 321 2 121 1989 
2 Al-Nakshabandi N   Percutaneous vertebroplasty in patients with osteoportic vertebral body fractures Ann Saudi Med 2008 28 2 120 123 18398276 
3 Kallmes DF  Jensen ME   Percutaneous Vertebroplasty Radiology 2003 229 128 
4 Murphy KJ  Lin DD   Vertebroplasty: a simple sollution to a difficult problem J Clin Densitom 2001 Fall 4 3 189 97 11740060 
5 Mathis MJ  Petri M  Naff N   Percutaneous verttebroplasty treatment of steroid-induced osteoporrotic compression fractures Arthritis Rheum 1998 41 171 175 9433883