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KMID : 0388720140210020070
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Journal of Korean Society of Spine Surgery
2014 Volume.21 No. 2 p.70 ~ p.75
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Outcome Comparison between Percutaneous Vertebroplasty and Conservative Treatment in Acute Painful Osteoporotic Vertebral Compression Fracture
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Na Hwa-Yeop
Lee Young-Sang
Park Tae-Hoon
Kim Tae-Hwan
Seo Kang-Won
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Abstract
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Study Design: A retrospective comparative study.
Objective: To compare the outcome of percutaneous vertebroplasty (VP) and conservative treatment for the treatment of acute painful osteoporotic vertebral compression fractures (VCF).
Summary of Literature Review: Vertebroplasty is a common procedure for the treatment of acute painful osteoporotic VCF. However, controversy still exists regarding clinical outcomes of the procedure compared with more conservative treatment.
Materials and Methods: A consecutive group of patients, undergoing VP and conservative treatment at our hospital, between July 2005 and October 2008, were reviewed retrospectively. All patients were reviewed with at least 1 year of follow up. A total of 58 patients underwent 59 VP procedures under local anesthesia at post injury 2 weeks; a total of 31 underwent conservative treatment. These two groups were compared by the kyphotic angle and loss of vertebral body height at immediate post-injury, post-injury 6weeks and 1y ear, radiologically. And they were compared by the visual analog scale(VAS) score and ambulatory status at the same time, clinically.
Results: At the time of immediate post-injury, six weeks after post-injury, one year after injury, height loss was 29.73%, 19.81%, 22.59% in the VP group, respectively, and 31.20%, 36.80%, 40.60% in the conservative treatment group, respectively. The Kyphotic angles were 13.44°, 9.10°, 11.31° in VP group, respectively, and 10.29°, 15.83°, 19.00° in the conservative treatment group, respectively. There was a statistically significant reduction of height loss and kyphotic angle in VP group at post-injury of 6 weeks and 1 year(p<0.05). At the same time, VAS scores were 9.41, 4.32, 2.47 in the VP group, respectively, and 9.50, 6.25, 2.71 in conservative treatment group, respectively. Ambulation status was 3.61, 1.46, 1.22 in the VP group, respectively, and 3.65, 2.45, 1.32 in the conservative treatment group, respectively. There was a statistically significant reduction of VAS score and improved ambulation status in VP group at post-6 weeks, but no difference between two groups at post 1 year. There was no significant difference in new fractures of adjacent vertebrae between the two groups (p>0.05).
Conclusions: VP prevents further collapse and kyphosis relieves pain quickly and allows early ambulation, but in post-injury 1 year follow up, there was no significant difference in clinical outcomes. Proper treatment should be done with respect to patient’s age, general condition, economic status and complication.
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KEYWORD
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Vertebral compression fracture, Osteoporosis, Vertebroplasty, Conservative treatment
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