Percutaneous vertebroplasty for subacute and chronic painful osteoporotic vertebral compression fractures can safely be undertaken in the first year after the onset of symptoms

Abstract

The optimal timing of percutaneous vertebroplasty as treatment for painful osteoporotic vertebral compression fractures (OVCFs) is still unclear. With the position of vertebroplasty having been challenged by recent placebo-controlled studies, appropriate timing gains importance. We investigated the relationship between the onset of symptoms - the time from fracture - and the efficacy of vertebroplasty in 115 patients with 216 painful subacute or chronic OVCFs (mean time from fracture 6.0 months (sd 2.9)). These patients were followed prospectively in the first post-operative year to assess the level of back pain and by means of health-related quality of life (HRQoL). We also investigated whether greater time from fracture resulted in a higher risk of complications or worse pre-operative condition, increased vertebral deformity or the development of nonunion of the fracture as demonstrated by the presence of an intravertebral cleft. It was found that there was an immediate and sustainable improvement in the level of back pain and HRQoL after vertebroplasty, which was independent of the time from fracture. Greater time from fracture was associated with neither worse pre-operative conditions nor increased vertebral deformity, nor with the presence of an intravertebral cleft. We conclude that vertebroplasty can be safely undertaken at an appropriate moment between two and 12 months following the onset of symptoms of an OVCF.

ACR Appropriateness Criteria® Management of Vertebral Compression Fractures

“…Studies have found VA to be superior to placebo intervention for pain reduction in patients with acute osteoporotic VCF of <6 weeks' duration [19]. As noted in Variant 1 in the study by Syed et al [30], patients with VCF >12 weeks compared to VCF <12 weeks had equivalent benefit suggesting that the age of the fracture does not independently affect the outcomes of VP, although there is evidence for treatment of subacute and chronic, painful compression fractures [18,20,28,29].…”

“…Percutaneous Vertebral Augmentation. VA may be a treatment option [33,61] for osteoporotic VCFs, as there is evidence that VA is associated with better pain relief and improved functional outcomes compared to conservative therapy [18,20,29,31]. VA has shown immediate and considerable improvement in pain and patient mobility.…”

“…Many studies have compared VP versus BK [21][22][23][24][25][26][27] and the timing of when VA is appropriate [18][19][20][28][29][30][31]. A thorough description of the indications and contraindications to VA are detailed in the ACR-ASNR-ASSR-SIR-SNIS Practice Parameter for the Performance of Vertebral Augmentation [32].…”

Earlier Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture May Minimize the Subsequent Development of Adjacent Fractures: A Retrospective Study

“…Cement augmentation procedures, including PVP or kyphoplasty, are now widely accepted for the treatment of OVCFs. These procedures reduce pain, improve patients' quality of life, and reduce the mortality of the geriatric population and were used for treatment of both acute and chronic vertebral fractures (13)(14)(15). However, an adjacent-level fracture may be accelerated by vertebroplasty and commonly occurs at the thoracolumbar junction (4,6).…”

A Review and Clinical Perspective of the Impact of Osteoporosis on the Spine

“…Fragility fracture and osteoporosis epidemiology References: 1,2,7-21 Treatment strategies and treatment deficiencies following fragility fracture References: [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Bone health and elective spine surgery outcomes References: 3,5,6, Osteoporosis treatment and elective spine surgery outcomes References: 8,39,[60][61][62][63][64][65][66][67][68] Table 3. 2016 AACE Diagnosis of Osteoporosis in Postmenopausal Women.…”