Abstract
The literature has classified chronic vertebral compression fractures (VCF) as those still "symptomatic" four or more months after onset. Pain is regarded as the predominant chronic symptom; however, radiologic changes are important in evaluating fracture progression. This review examines a series of patients with chronic fractures and both persistence of spinal pain combined with radiologic changes, such as worsening collapse, spinal angulation, the development of vertebral edema and clefts, as well as the development of new fractures at adjacent spinal levels. In patients with clear progressive radiologic changes in addition to pain, vertebral augmentation on an average of 9.3 months after injury was effective in reducing the pain and stabilizing these more chronic osteoporotic fractures. A comparison of the pre- and post-procedure visual analog scale score (VAS) indicated an average of 66% reduction in pain. There are several reasons for the development of chronic symptomatic fractures. Most commonly, interventional treatment is delayed in a patient already diagnosed with VCF after a long period of conservative treatment, yet pain persists, or the initial clinical and radiologic evaluation misses the fracture, leading to a delay in diagnosis and treatment. In this report, management in these patients and the role of late vertebral augmentation for chronic symptomatic fractures is clarified based on the findings of various radiologic changes seen on both initial and follow-up radiologic studies.
Highlights
The use of vertebroplasty (VP), vertebral augmentation (VA), or kyphoplasty (KP) to treat osteoporotic vertebral compression fractures (VCF) and the timing of these procedures is debated in the literature since the majority of patients resolve their initial pain and often go on to fracture healing with conservative treatment, including initial bracing and later spinal extension exercises and the medical management of the underlying osteopenia and osteoporosis [1]
This review examines a series of patients with chronic fractures and both persistence of spinal pain combined with radiologic changes, such as worsening collapse, spinal angulation, the development of vertebral edema and clefts, as well as the development of new fractures at adjacent spinal levels
If there is a significant delay in diagnosis or a missed diagnosis of persistent pain after a long period of conservative treatment, the question arises if treating the fracture with VP or KP is still effective in relieving chronic pain in selected patients
Summary
The use of vertebroplasty (VP), vertebral augmentation (VA), or kyphoplasty (KP) to treat osteoporotic vertebral compression fractures (VCF) and the timing of these procedures is debated in the literature since the majority of patients resolve their initial pain and often go on to fracture healing with conservative treatment, including initial bracing and later spinal extension exercises and the medical management of the underlying osteopenia and osteoporosis [1]. Interventional treatment has been reported to be effective as long as 24 months after onset for chronic pain secondary to VCF [4]. Reports on the treatment of more chronic fractures have not addressed the radiologic findings that may indicate in which cases late VA or KP may be effective it is clear that patients can get significant pain relief [4,5,6]. This review will examine a group of 31 patients from three different centers with chronic fractures that were treated with late vertebroplasty or vertebral augmentation at least four months after the original onset of the fracture. The study will examine the distribution of these fractures and radiologic characteristics on magnetic resonance imaging (MRI) and computed tomography (CT) scan as well as associated kyphosis and scoliosis
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