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The North American Spine Society and the Society of Interventional Radiology have pointed to flaws in both studies. And earlier studies, published over 15 years, found major benefits to kyphoplasty and a related procedure called vertebroplasty. "We're missing opportunities for patients to receive a safe and effective treatment that can significantly reduce their pain and disability," said Malamis, an interventional radiologist. The procedures are used to treat vertebral compression fractures in patients with osteoporosis and other conditions that result in brittle bones. In a vertebroplasty, an acrylic cement is injected into a fractured vertebra. In a kyphoplasty, a balloon-tipped catheter first is inserted into the fracture. The balloon is inflated to restore the height and shape of the vertebra before the cement is injected. Neva Nelson, 74, of Naperville, Ill., said a kyphoplasty that Malamis performed in October, 2009, has greatly reduced her pain in a vertebra in her lower back that she fractured after falling on ice. Before her kyphoplasty, Nelson had to sit on cushions. Walking, and especially standing, were painful. "I had to do something," she said. "I could not go on like that." Nelson said that since undergoing her kyphoplasty, "I don't have to worry about my back any more." In the controversial studies, patients were randomly assigned to receive a vertebroplasty or a placebo-like "sham" procedure. In the sham procedure, patients received an injection of anesthetic, but no cement. However, patients in severe pain are reluctant to enroll in a trial where there's a 50 percent chance of receiving a sham treatment. In one of the studies, researchers had to screen 1,813 patients to enroll just 131 subjects. In the other study, only 78 of 219 eligible patients were enrolled. This low enrollment rate raises the possibility that the patients who did enroll were not representative. Patients experience the greatest pain during the first three months after a compression fracture. Thereafter, pain gradually subsides. Thus, a vertebroplasty or kyphoplasty provides the greatest benefit when performed within a week or two of the fracture. But the studies enrolled patients up to 12 months after fractures. In addition to reducing pain and disability, a kyphoplasty can reduce the risk of subsequent fractures by improving the angle and height of the spine. The studies evaluated vertebroplasty alone, and did not include the more innovative and very different kyphoplasty procedure. Malamis suggests the medical community wait for the results of additional studies now underway before passing final judgment on vertebroplasty or kyphoplasty. In the mean time, he notes that Medicare still covers the procedures.

The team observed viruses as they evolved over hundreds of generations to infect bacteria. They found that when the bacteria could evolve defences, the viruses evolved at a quicker rate and generated greater diversity, compared to situations where the bacteria were unable to adapt to the viral infection. The study shows, for the first time, that the American evolutionary biologist Leigh Van Valen was correct in his 'Red Queen Hypothesis'. The theory, first put forward in the 1970s, was named after a passage in Lewis Carroll's Through the Looking Glass in which the Red Queen tells Alice, 'It takes all the running you can do to keep in the same place'. This suggested that species were in a constant race for survival and have to continue to evolve new ways of defending themselves throughout time. Dr Steve Paterson, from the University's School of Biosciences, explains: "Historically, it was assumed that most evolution was driven by a need to adapt to the environment or habitat. The Red Queen Hypothesis challenged this by pointing out that actually most natural selection will arise from co-evolutionary interactions with other species, not from interactions with the environment. "This suggested that evolutionary change was created by 'tit-for-tat' adaptations by species in constant combat. This theory is widely accepted in the science community, but this is the first time we have been able to show evidence of it in an experiment with living things." Dr Michael Brockhurst said: "We used fast-evolving viruses so that we could observe hundreds of generations of evolution. We found that for every viral strategy of attack, the bacteria would adapt to defend itself, which triggered an endless cycle of co-evolutionary change. We compared this with evolution against a fixed target, by disabling the bacteria's ability to adapt to the virus. "These experiments showed us that co-evolutionary interactions between species result in more genetically diverse populations, compared to instances where the host was not able to adapt to the parasite. The virus was also able to evolve twice as quickly when the bacteria were allowed to evolve alongside it."