Percutaneous vertebroplasty vs conservative treatment for osteoporotic thoracolumbar vertebral fractures: a comparative study

English Keywords:Vertebral fracture  Percutaneous vertebroplasty  Conservative management  Osteoporosis  Comparative study

English Abstract:

  【Abstract】 Objectives: To prospectively compare the clinical outcome of painful osteoporotic thoracolumbar vertebral compression fractures(VCF) treated by percutaneous vertebroplasty(PVP) or conservative management. Methods: 72 consecutive patients aged 55 years or older from December 2009 to August 2011 in our hospital were enrolled in this study. All patients suffered from vertebral compression fracture evidenced bone oedema on MRI, and the VAS score was ≥6 and lasted for 6 weeks or less. The exclusion criteria included other unclear spinal disorders, history of stroke, senile dementia, malignancy, long-term oral corticosteroid use, major medical diseases requiring intensive treatment, metastatic spinal tumor, myeloma, hemangioma or infection, residual vertebral height less than 25% and noncorrectable coagulopathy. Patients were allocated to PVP group(n=39) or conservative treatment group(n=33) according to patients′ desire. VAS for pain and Oswestry disability index(ODI) questionnaire scores were assessed and compared before treatment and at 1 week, 1, 3, 6, 12 and 24 months after treatment. The patient age, sex, body weight, duration of VCF(s), vertebral levels, the loss of vertebral height, CT value of nonfractured vertebrae, number of VCF(s), VAS and ODI scores between the two groups were documented and compared. Results: Two patients with continued pain transferred to PVP group after 2 and 3 weeks′ conservative therapy. Both PVP and conservative treatment provided pain relief or physical function improvement. All the patients in both PVP and conservative treatment groups completed the 6-month follow-up period. There were 33 and 10 patients in PVP group and 28 and 12 in conservative treatment group who completed the 12 or 24-month follow-up period, respectively. VAS and ODI scores decreased significantly(P<0.05) in PVP at 1 week, but those in conservative group decreased significantly at 1 month after treatment. VAS and ODI score decreased more significantly in PVP group at 1 week and at 1, 3, 6 and 12 months compared with conservative group(all P<0.05), while no statistical significance was noted between two groups with respect to VAS and ODI scores at 24 months, but the percentage(9/10, 90.0%) of no pain cases in PVP group was higher than that in conservative group(8/12, 66.7%). One patient in PVP group and two patients in conservative group had 1 and 3 onset vertebral fracture respectively. Conclusions: Both PVP and conservative treatment are effective for the painful osteoporotic thoracolumbar VCFs. PVP has immediate pain relief and functional improvement compared with conservative treatment.