Abstract
Vertebroplasty is an effective treatment for painful compression fractures refractory to conservative management. Because there are limited data regarding the survival characteristics of this patient population, we compared the survival of a treated with an untreated vertebral fracture cohort to determine whether vertebroplasty affects mortality rates. The survival of a treated cohort, comprising 524 vertebroplasty recipients with refractory osteoporotic vertebral compression fractures, was compared with a separate historical cohort of 589 subjects with fractures not treated by vertebroplasty who were identified from the Rochester Epidemiology Project. Mortality was compared between cohorts by using Cox proportional hazards models adjusting for age, sex, and Charlson indices of comorbidity. Mortality was also correlated with pre-, peri-, and postprocedural clinical metrics (eg, cement volume use, RDQ score, analog pain scales, frequency of narcotic use, and improvement in mobility) within the treated cohort. Vertebroplasty recipients demonstrated 77% of the survival expected for individuals of similar age, ethnicity, and sex within the US population. Compared with individuals with both symptomatic and asymptomatic untreated vertebral fractures, vertebroplasty recipients retained a 17% greater mortality risk. However, compared with symptomatic untreated vertebral fractures, vertebroplasty recipients had no increased mortality following adjustment for differences in age, sex, and comorbidity (HR, 1.02; 95% CI, 0.82-1.25). In addition, no clinical metrics used to assess the efficacy of vertebroplasty were predictive of survival. Vertebroplasty recipients have mortality rates similar to those of individuals with untreated symptomatic fractures but have worse mortality compared with those with asymptomatic vertebral fractures.
Highlights
AND PURPOSE: Vertebroplasty is an effective treatment for painful compression fractures refractory to conservative management
Osteoporotic fractures of the spine are extremely common,[1] and the lifetime risk of a symptomatic vertebral compression fracture has been estimated at 18% for women and 11% for men.[2]
AJNR Am J Neuroradiol 32:1818 –23 ͉ Nov 2011 ͉ www.ajnr.org 1819 vertebroplasty for chronic severe back pain in 1999 –2007, whereas the untreated group comprised 589 Rochester residents meeting inclusion/exclusion criteria who were diagnosed with vertebral compression fractures in 1985–1994
Summary
The survival of a treated cohort, comprising 524 vertebroplasty recipients with refractory osteoporotic vertebral compression fractures, was compared with a separate historical cohort of 589 subjects with fractures not treated by vertebroplasty who were identified from the Rochester Epidemiology Project. Study Population A retrospective study design was implemented that involved 2 separate patient populations: The treated cohort comprised patients who underwent vertebroplasty for osteoporotic compression fractures at our institution between February 1999 and February 2007 Many of these vertebroplasty recipients have been included in several publications investigating short- and long-term outcomes and subsequent fracture,[17,18,19,28] but none of those reports addressed mortality. For this analysis, the vertebroplasty cohort was limited to patients with benign compression fractures of the vertebral body between T1 and L5 in the setting of clinical symptoms and radiologic evidence of osteoporosis. These models were run overall by subsets of Charlson index scores and were used to assess the impact of various covariates on death within the treated group
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