Dear Editor,

Aquarius, Schepers-Bok, and Homminga raise a point that is philosophically valid. The patients whom we treated had persistent pain; we did not treat patients with acute pain. In principle, it could be that for acute pain, a different explanation applies than the one that we proffered for persistent pain.

However, suggesting a different mechanism is not the same as validating it. We still have no evidence, in acute or chronic cases, that pain stems from the fracture and, therefore, vindicates vertobroplasty. In the absence of evidence vertobroplasty remains a fashion stained by contradictory and contentious outcome data.

Yours sincerely,