Clinical study
Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy

https://doi.org/10.1016/S0002-9343(02)01524-3Get rights and content

Abstract

Purpose

We sought to determine whether percutaneous vertebroplasty—which involves the injection of cement to stabilize a fractured vertebral body—may be an effective treatment for vertebral fracture.

Methods

We enrolled 79 consecutive osteoporotic patients (24 men and 55 women; ages 51 to 93 years) presenting with acute vertebral fractures. Clinical characteristics and bone densitometry were measured at baseline. Pain scores (on a 0 to 25 scale) and levels of function (on a 0 to 20 scale) were recorded on presentation, at 24 hours, at 6 weeks, and 6 to 12 months after therapy.

Results

Fifty-five patients (70%) were treated by percutaneous vertebroplasty and 24 (30%) were treated by conservative therapy alone. They were followed for a mean of 215 days (range, 57 to 399 days). The baseline clinical characteristics, bone densitometry, and fracture data were similar in the two groups. Twenty-four hours after vertebroplasty, there was a 53% reduction in pain scores (from 19 to 9; P = 0.0001) and a 29% improvement in physical functioning (from 14 to 18; P = 0.0001), whereas pain scores and physical functioning remained unchanged at 24 hours in the patients treated conservatively (both P = 0.0001 compared with the changes after percutaneous vertebroplasty). Thirteen patients (24%) treated by percutaneous vertebroplasty were able to cease all analgesia after 24 hours (P = 0.0001 compared with none of the 24 patients treated conservatively). Clinical outcomes at 6 weeks and 6 to 12 months were similar in both groups.

Conclusion

When compared with conservative therapy, percutaneous vertebroplasty results in prompt pain relief and rapid rehabilitation. In experienced hands, it is a safe and effective procedure for treating acute osteoporotic vertebral compression fractures.

Section snippets

Patients and eligibility

All patients presenting to the emergency department (n = 37) of, or admitted as inpatients (n = 42) to, The Saint George Hospital from November 2000 to December 2001 with acute vertebral fracture syndrome were considered for the study. Inclusion criteria were acute severe vertebral fracture pain, densitometric evidence of osteoporosis, and acute fracture activity on magnetic resonance imaging or technetium-99m bone scan. Exclusion criteria were pathologic fracture due to myeloma/metastasis,

Results

The 24 men (30%) and 55 women (77%) in the study were followed for a mean of 215 days (range, 57 to 399 days), and they ranged from 51 to 93 years in age. Percutaneous vertebroplasty was performed in 55 patients (70%) on 71 vertebras, including 45 thoracic vertebras (T5 = 3, T6 = 2, T7 = 6, T8 = 11, T9 = 11, T10 = 2, T11 = 2, and T12 = 8) and 26 lumbar vertebras (L1 = 8, L2 = 6, L3 = 5, L4 = 3, and L5 = 4). One vertebra was injected in 42 patients, two vertebras in 11 patients, three vertebras

Discussion

Until recently, bed rest, narcotic analgesia, and physical support were the only treatments for acute vertebral compression fractures, and these had limited efficacy (21). Percutaneous vertebroplasty, which was designed for treating aggressive angiomas, bone metastases, and myeloma 8, 22, has been used increasingly for the management of acute osteoporotic vertebral fractures 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. However, previous studies have been short in duration and have not had a

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  • Cited by (0)

    1

    Dr. Clark is employed as an interventional radiologist by Mayne Health Diagnostics, Saint George Private Hospital, Sydney, Australia.

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