Vertebral Augmentation is Superior to Nonoperative Care at Reducing Lower Back Pain for Symptomatic Osteoporotic Compression Fractures

Pourtaheri, Sina; Luo, William; Cui, Christina; Garfin, Steven R.

doi:10.1097/bsd.0000000000000670

Cited by 11 publications

(5 citation statements)

References 29 publications

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“…It has been reported that the incidence of non-union in conservative treatment of OVCFs generally ranges from 10-20% [1,4]. In this study, the non-union rate in the low-score group was 2.1%, whereas in the highscore group, it was 67.3%.…”

Section: Discussionmentioning

confidence: 49%

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A New Assessment System of Osteoporotic Vertebral Compression Fractures: A Retrospective Study

Cong

Zhen

et al. 2023

Preprint

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Background We have developed a new scoring system that specifically designed for osteoporotic vertebral compression fractures (OVCFs) to guide treatment selection. This system evaluates four aspects: fracture type, fracture morphology, MRI signal changes, and bone mineral density. Methods From March 2016 to March 2021, we conducted a retrospective study of radiographic and clinical data from 208 patients who underwent conservative treatment for OVCFs. Based on the new assessment system of osteoporotic vertebral compression fractures (NASOVCF) scores, the patients were divided into low (48 cases), medium (108 cases), and high (52 cases) score groups. We compared the visual analog scale (VAS), Oswestry Disability Index (ODI) scores, vertebral height loss, kyphosis angle, and bone union rate among the three groups. Logistic regression analysis was used to determine the relationship between bone non-union and independent variables. Results The low-score group showed significantly lower VAS and ODI scores both before treatment and at the follow-up compared to the medium-score and high-score groups (P < 0.05). Additionally, the low-score group had significantly lower vertebral height loss and kyphosis angle differences compared to the medium-score and high-score groups. The bone union rate in the low-score group was 97.9%, which was significantly higher than the rates of 75% in the medium-score group and 32.7% in the high-score group. The high-score group had a significantly higher risk of non-union compared to the low-score group (OR = 88.78; P = 0.001) and the medium-score group (OR = 15.67; P = 0.001). Additionally, female gender (OR = 3.20, P = 0.014), ODI at pre-treatment (OR = 1.11, P = 0.009), and NASOVCF score (OR = 2.59, P = 0.000) were identified as independent risk factors for bone non-union. Conclusions Based on the NASOVCF scoring system, the low-score group showed superior outcomes in terms of pain relief, functional improvement, prevention of vertebral height loss and worsening spinal kyphosis, as well as a higher bone union rate, compared to the medium-score and high-score groups. Therefore, conservative treatment is recommended for OVCF patients with a score of 3 or less, while surgical treatment is recommended for patients with a score of 7 or higher.

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Section: Discussionmentioning

confidence: 49%

“…However, conservative treatment may require a longer rehabilitation process, especially for severe fractures, which may take more time to pain relief and functional recovery. Therefore, some scholars advocate for active surgical treatment [4].…”

mentioning

confidence: 99%

A New Assessment System of Osteoporotic Vertebral Compression Fractures: A Retrospective Study

Cong

Zhen

et al. 2023

Preprint

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“…OVCF is a common complication in patients with osteoporosis, compared with the conservative treatment of only using drugs and braces, surgical treatment can reduce pain and improve the ability of movement, if the patients do not undergo surgical treatment in time, the vertebral body may continue to collapse, the activity ability of the patient will be weakened, the pain can not be relieved, which result in a low quality of life (14). VA is the main surgical method for OVCFs, and is characterized by reduced trauma, less bleeding, rapid postoperative recovery, and high safety (15).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of vertebral augmentation in the treatment of osteoporotic vertebral compression fractures: a systematic review and meta-analysis

Lin¹,

Cheng²,

Liang³

et al. 2021

Ann Palliat Med

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“…Although there is substantial clinical evidence on the safety and effectiveness of both VP and BK for osteoporotic vertebral fractures (OVF) providing greater pain relief and functional recovery than CM [22][23][24][25][26] the costeffectiveness of these procedures is less well known. We previously conducted an up-to-date systematic review of peer-reviewed studies evaluating cost-effectiveness of these procedures for OVFs.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Cost-effectiveness and willing-to-pay thresholds for vertebral augmentation of osteoporotic vertebral fractures, what are they based on: a systematic review

Pron¹,

Hwang²,

Nasralla³

et al. 2023

BMJ Open

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ObjectiveAlthough there is substantial clinical evidence on the safety and effectiveness of vertebral augmentation for osteoporotic vertebral fractures, cost-effectiveness is less well known. The objective of this study is to provide a systematic review of cost-effectiveness studies and policy-based willingness-to-pay (WTP) thresholds for different vertebral augmentation (VA) procedures, vertebroplasty (VP) and balloon kyphoplasty (BK), for osteoporotic vertebral fractures (OVFs).DesignA systematic review targeting cost-effectiveness studies of VA procedures for OVFs.Data sourcesSix bibliographic databases were searched from inception up to May 2021.Eligibility criteria for study selectionStudies were eligible if meeting all predefined criteria: (1) VP or BK intervention, (2) OVFs and (3) cost-effectiveness study. Articles not written in English, abstracts, editorials, reviews and those reporting only cost data were excluded.Data extraction and synthesisInformation was extracted on study characteristics, cost-effective estimates, summary decisions and payer WTP thresholds. Incremental cost-effective ratio (ICER) was the main outcome measure. Studies were summarised by a structured narrative synthesis organised by comparisons with conservative management (CM). Two independent reviewers assessed the quality (risk of bias) of the systematic review and cost-effectiveness studies by peer-reviewed checklists.ResultsWe identified 520 references through database searching and 501 were excluded as ineligible by titles and abstract. Ten reports were identified as eligible from 19 full-text reviews. ICER for VP versus CM evaluated as cost per quality-adjusted life-year (QALY) ranged from €22 685 (*US$33 395) in Netherlands to £−2240 (*US$−3273), a cost-saving in the UK. ICERs for BK versus CM ranged from £2706 (*US$3954) in UK to kr600 000 (*US$90 910) in Sweden. ICERs were within payer WTP thresholds for a QALY based on historical benchmarks.ConclusionsBoth VP and BK were judged cost-effective alternatives to CM for OVFs in economic studies and were within WTP thresholds in multiple healthcare settings.

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Vertebral Augmentation is Superior to Nonoperative Care at Reducing Lower Back Pain for Symptomatic Osteoporotic Compression Fractures

Cited by 11 publications

References 29 publications

A New Assessment System of Osteoporotic Vertebral Compression Fractures: A Retrospective Study

A New Assessment System of Osteoporotic Vertebral Compression Fractures: A Retrospective Study

Efficacy of vertebral augmentation in the treatment of osteoporotic vertebral compression fractures: a systematic review and meta-analysis

Cost-effectiveness and willing-to-pay thresholds for vertebral augmentation of osteoporotic vertebral fractures, what are they based on: a systematic review

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