Another chapter for vertebral compression fractures

Abstract

Every year, 1·4 million patients present with vertebral compression fractures worldwide. 1 Johnell O Kanis JA An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006; 17: 1726-1733 Crossref PubMed Scopus (2858) Google Scholar These fractures cause pain, disability, and diminished quality of life, 2 Borgstrom F Zethraeus N Johnell O et al. Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int. 2006; 17: 637-650 Crossref PubMed Scopus (244) Google Scholar , 3 Silverman SL Minshall ME Shen W Harper KD Xie S on behalf of the Health-Related Quality of Life Subgroup of the Multiple Outcomes of Raloxifene Evaluation StudyThe relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis: results from the Multiple Outcomes of Raloxifene Evaluation Study. Arthritis Rheum. 2001; 44: 2611-2619 Crossref PubMed Scopus (294) Google Scholar and are associated with an increased risk of future vertebral fractures. 4 Lindsay R Silverman SL Cooper C et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001; 285: 320-323 Crossref PubMed Scopus (1447) Google Scholar Most of these fractures are due to osteoporosis and occur spontaneously or with minimum trauma, and the vertebrae heal in a deformed state with non-surgical management that includes analgesia, bed rest, physiotherapy, and back bracing. Pain can resolve slowly and persist. 5 Lyritis GP Mayasis B Tsakalakos N et al. The natural history of the osteoporotic vertebral fracture. Clin Rheumatol. 1989; 8: 66-69 Crossref PubMed Scopus (106) Google Scholar Further fractures result in vertebral deformity, height loss, kyphosis, decreased pulmonary function, and mobility and balance impairment. 5 Lyritis GP Mayasis B Tsakalakos N et al. The natural history of the osteoporotic vertebral fracture. Clin Rheumatol. 1989; 8: 66-69 Crossref PubMed Scopus (106) Google Scholar , 6 Schlaich C Minne HW Bruckner T et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int. 1998; 8: 261-267 Crossref PubMed Scopus (417) Google Scholar , 7 Lyles KW Gold DT Shipp KM Pieper CF Martinez S Mulhausen PL Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med. 1993; 94: 595-601 Summary Full Text PDF PubMed Scopus (358) Google Scholar What is the point of surgery?On an individual level, surgery relieves pain, restores function, improves quality of life, and saves lives. In what manner and to what end do these services engage in broader terms with the health of populations? 1 year ago, The Lancet published a surgery-themed issue that introduced the IDEAL recommendations to improve surgical research. In that issue, Ara Darzi and colleagues challenged surgeons to transform their specialty into a word-class discipline. Today's Lancet returns to the theme of surgery to assess what progress has been made. Full-Text PDF Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trialIn a subgroup of patients with acute osteoporotic vertebral compression fractures and persistent pain, percutaneous vertebroplasty is effective and safe. Pain relief after vertebroplasty is immediate, is sustained for at least a year, and is significantly greater than that achieved with conservative treatment, at an acceptable cost. Full-Text PDF