Long Term Survival of Pathological Thoracolumbar Fractures Treated with Vertebroplasty: Analysis Using a Nationwide Insurance Claim Database

Abstract

Background: There are still debates on the long-term outcome of treating pathological thoracolumbar fractures, including osteoporosis and oncologic problems, using vertebroplasty. Methods: We collected 8625 patients with pathological thoracolumbar fractures (ICD-9-CM codes 733.13 combined with 805.2 or 805.4) between the years of 2003 to 2013, from the two million random samples from the National Health Insurance Research Database in Taiwan. Survival analysis was conducted to estimate the mortality risks of different treatments, including vertebroplasty (n = 1389), conventional open surgery (n = 1219), or conservative treatment (n = 6017). A multivariable Cox proportional hazard model was constructed for adjustment of age, gender, comorbidities and complications. Results: Crude incidence rate of patients with pathological thoracolumbar fractures in Taiwan gradually increased year by year. Compared with conservative treatment, conventional open surgery and vertebroplasty seemed to improve long-term survival with adjusted hazard ratios (aHR) of 0.80 (95% confidence interval (CI) 0.70–0.93), and 0.87 (95% CI 0.77–0.99), respectively. The survival advantage of vertebroplasty appeared more evident for those aged over 75. However, we were unable to rule out confounding by indication. Conclusion: Although conventional open surgery would usually be the best choice for the treatment of patients with pathological thoracolumbar fractures, database information from current real-world practice appears to support vertebroplasty as a viable choice for elderly people over 75 years of age.

Osteoporotic Vertebral Body Fractures: New Trends in Differential Diagnosis, Bracing and Surgery

“…Some authors explored the long-term mortality and survival after VP or BK performed for pathological OVFs compared with conservative treatment, and they found that BK had better survival than VP, whereas both BK and VP have better survival than the conservative treatment [ 12 , 13 ]. Kuo-Yuan Huang [ 14 ] in a retrospective study compared the long-term survival and complications of the patients with osteoporotic and oncologic TL fractures who received VP, BK, open surgery, or conservative treatment. There are only few studies [ 15 ] comparing the long-term survival of pathological TL fractures treated with VP, conventional open surgery, and conservative treatment, as well as their related complications (pulmonary embolism, PMMA leakage, shock or death; vertebral infection or osteomyelitis, adjacent vertebral fractures).…”

“…Although some research showed both VP and BK were better than conservative treatment or sham procedures without cement, and BK may be better than VP in restoring the vertebral height and in possibly providing better survival [ 16 , 17 ], other studies [ 16 , 18 ] did not show consistent results, especially on patients with compression fractures. Although VP is less invasive, and clinical observations found that elderly patients with TL fractures recovered faster after VP with a shorter stay of hospitalization and lower medical expense compared with conventional anterior and posterior spinal decompression or fusion surgeries, Kuo-Yuan Huang [ 14 ] did not collect the data on patients’ quality of life and are unable to make any inference on how it improves patient’s function and quality of life.…”