Painful Osteoporotic Vertebral Fracture

Rao, Raj D.; Singrakhia, Manoj

doi:10.2106/00004623-200310000-00024

Cited by 170 publications

(36 citation statements)

References 67 publications

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“…However, in a recent prospective series 20 patients treated with KP had chronic pain of more than 12 months duration and still there were improvements in vertebral body height, pain and mobility compared to the preoperative status. The authors of the present study, in accordance with others, believe that one month is the minimum waiting period before considering surgery because of the natural history of osteoporotic VCFs and the higher risk of cement leakage within the first month from fracture 10,15 . We then suggest that after 1 month of failed conservative treatment, VP must be considered for persistent painful fractures with a VBC less than 30%, whereas KP is considered for fractures that had progressed to a vertebral body collapse equal or higher than 30% within the third month (Figure 1).…”

Section: Discusãosupporting

confidence: 87%

“…Patients whose bone histology did not show features of osteoporosis (osteomalacia or neoplasm) were excluded from the study. VCFs were defined as those fractures that showed a vertebral body collapse (VBC) of at least 20% 10 , comparing the absolute values of three vertical body heights (anterior, mid-vertebral and posterior) of the fractured vertebra with the vertebra above ("referent" vertebra) on plain lateral radiographs 11 . Two-plane radiographs of the affected spinal region and Magnetic Resonance Imaging (MRI) of the whole spine were obtained in all patients at observation 4,5,12 .…”

Section: Methodsmentioning

confidence: 99%

“…Symptomatic levels were identified by correlating the clinical findings (i.e. pain on pressure and tapping over the spinous processes), with MRI findings of marrow signal changes on Short Tau Inversion Recovery (STIR) sequences consistent with the presence of compression fractures at the symptomatic levels 4,10,13 . Minimum follow-up for evaluation of data was set at two years.…”

Section: Methodsmentioning

confidence: 99%

“…Conservative treatment consisted of a period of relative bed rest and analgesia, with the application of a thoraco-lumbar extension orthosis while standing 10 .…”

Section: Methodsmentioning

confidence: 99%

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Vertebroplasty and kyphoplasty: complementary tecniques for the treatment of painful osteoporotic vertebral compression fractures

et al. 2009

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OBJECTIVE: in a prospective study, we aimed to evaluate the potential use of kyphoplasty (KP) and vertebroplasty (VP) as complementary techniques in the treatment of painful osteoporotic vertebral compression fractures (VCFs). METHODS: after one month of conservative treatment for VCFs, patients with intractable pain were offered treatment with KP or VP according to a treatment algorithm that considers time from fracture (Ät) and amount of Vertebral Body Collapse (VBC). Bone biopsy was obtained intraoperatively to exclude patients affected by malignancy or osteomalacia. RESULTS: hundred and sixty-four patients were included according to the above criteria. Mean age was 67.6 years. Mean followup was 33 months. Ten patients (6.1%) were lost to follow-up and 154 reached the minimum two years follow-up. 118 (69.5%) underwent VP and 36 (30.5%) underwent KP. Complications affected five patients treated with VP, whose one suffered a transient intercostal neuropathy and four a subsequent VCF (two at adjacent level). Results in terms of VAS and Oswestry scores were not different among treatment groups. CONCLUSION: in conclusion, at an average follow-up of almost 3 years from surgical treatment of osteoporotic VCFs, VP and KP show similar good clinical outcomes and appear to be complementary techniques with specific different indications.

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Section: Discusãosupporting

confidence: 87%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Conservative treatment consisted of a period of relative bed rest and analgesia, with the application of a thoraco-lumbar extension orthosis while standing 10 .…”

Section: Methodsmentioning

confidence: 99%

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Vertebroplasty and kyphoplasty: complementary tecniques for the treatment of painful osteoporotic vertebral compression fractures

et al. 2009

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“…Initial treatment of VCF includes activity modification and analgesic medications [48,49]. Patients are often unable to tolerate activities of daily living and may require bed rest to control pain.…”

Section: Introductionmentioning

confidence: 99%

Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

Zampini

White

McGuire

2010

Clinical Orthopaedics &Amp; Related Research

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Background The majority of the 700,000 osteoporotic vertebral compression fractures (VCFs) that occur annually in the United States affect women. The total treatment costs exceed $17 billion and approximate the total costs of breast cancer ($13 billion) and heart disease ($19 billion). Balloon-assisted percutaneous vertebral augmentation with bone cement (kyphoplasty) reportedly reduces VCF-related pain and accelerates return of independent functional mobility. Kyphoplasty may decrease overall cost of VCF treatment costs by reducing use of posttreatment medical resources. Questions/purposes We evaluated complications, mortality, posthospital disposition, and treatment costs of kyphoplasty compared with nonoperative treatment using the Nationwide Inpatient Sample database.Methods We identified 5766 VCFs (71% female) in patients 65 years of age or older with nonneoplastic VCF as the primary diagnosis in nonroutine hospital admissions; 15.3% underwent kyphoplasty. Demographic data, medical comorbidities, and fracture treatment type were recorded. Outcomes, including complications, mortality, posthospital disposition, and treatment costs, were compared for each treatment type. Results Women were more likely to be treated with kyphoplasty than were men. Patients undergoing kyphoplasty had comorbidity indices equivalent to those treated nonoperatively. Kyphoplasty was associated with a greater likelihood of routine discharge to home (38.4% versus 21.0% for nonoperative treatment), a lower rate of discharge to skilled nursing (26.1% versus 34.8%) or other facilities (35.7% versus 47.1%), a complication rate equivalent to nonoperative treatment (1.7% versus 1.0%), and a lower rate of in-hospital mortality (0.3% versus 1.6%). Kyphoplasty was associated with higher cost of hospitalization (mean $37,231 versus $20,112).

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Vertebral body density role in determining vertebral osteoporotic fracture type and its progression

Smorgick,

Pelleg‐Kallevag,

Lindner

et al. 2024

Clinical Anatomy

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Vertebral osteoporotic fractures (VOF) are among the most frequent fractures in the elderly, often leading to an impaired lifestyle and a high economic burden. Although a reduced bone mass density is considered one of the main risk factors for VOF, its role in determining the fracture type, using the AO spine‐DGOU classification for osteoporotic thoracolumbar fractures, as well as its progression, is unknown. The current study aimed to: (1) reveal whether the bone density of the vertebral bodies of fractured and non‐fractured vertebrae predicts the type of fracture, (2) examine whether bone density is associated with the initial and progressive collapse of the vertebral body, and (3) provide predictive measures for fracture progression. The study sample included 124 patients (40 males and 84 females) with an acute osteoporotic vertebral fracture who underwent a computerized tomography scan at the time of diagnosis and an x‐ray at least 3 months later. The bone density of the fractured and adjacent (non‐fractured) vertebrae was measured at diagnosis. The magnitude of the collapse and the progression of the fracture over time were calculated from height measurements of the vertebral bodies at diagnosis and follow‐up. Age was a significant factor in predicting the fracture type and magnitude of collapse, whereas sex and bone density were not. The severity of the fracture was involved in predicting its progression, demonstrating that severe‐type fractures tended to continue to collapse after diagnosis. However, when each type was examined independently, the density of the fractured vertebra had a protective effect on fracture progression. To conclude, identifying the type of fracture is beneficial in determining patient prognosis. Furthermore, the density of the fractured vertebra, the magnitude of collapse, and patient age are valuable predictors of fracture progression.

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Painful Osteoporotic Vertebral Fracture

Cited by 170 publications

References 67 publications

Vertebroplasty and kyphoplasty: complementary tecniques for the treatment of painful osteoporotic vertebral compression fractures

Vertebroplasty and kyphoplasty: complementary tecniques for the treatment of painful osteoporotic vertebral compression fractures

Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

Vertebral body density role in determining vertebral osteoporotic fracture type and its progression

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