Vertebral Augmentation Compared to Conservative Treatment of Vertebra Plana and High-Degree Osteoporotic Vertebral Fractures: A Review of 110 Fractures in 100 Patients.

David M Joyce,Michelle Granville,Aldo Berti,Robert E Jacobson

doi:10.7759/cureus.22006

Abstract

This is a retrospective study that evaluated surgical versus non-surgical treatment of 100 patients followed for up to six years diagnosed with severe osteoporotic vertebral compression fractures (VCF). Fractures were classified by percent collapse of vertebral body height as "high-degree fractures" (HDF) (>50%) or vertebra plana (VP) (>70%). A total of 310 patients with VCF were reviewed, identifying 110 severe fractures in 100 patients. The HDF group was composed of 47 patients with a total of 50 fractures. The VP group was composed of 53 patients with a total of 60 fractures. Surgical intervention was performed in 59 patients, comprised entirely of percutaneous vertebral cement augmentation procedures, including vertebroplasty, balloon kyphoplasty, or cement with expandable titanium implants. The remaining 41 patients only underwent conservative treatment that is the basis of the comparison study. All procedures were performed as an outpatient under local anesthesia with minimal sedation and there were no procedural complications. The initial or pre-procedural visual analog scale (VAS) score averaged 8.4 in all patients, with surgical patients having the most marked drop in VAS, averaging four points. This efficacy was achieved to a greater degree in surgically treated VP fractures compared to HDF. Non-surgical patients persisted with the most pain in both short- and long-term follow-up. This large series, with follow-up up to six years, demonstrated that the more severe fractures respond well to different percutaneous cement augmentation procedures with reduction of pain without increased complications in a comparison to conservatively treated patients.

Highlights

Most of the osteoporotic vertebral compression fractures are related to falls or load injuries on an underlying osteoporotic spine in elderly patients
This is a retrospective study that evaluated surgical versus non-surgical treatment of 100 patients followed for up to six years diagnosed with severe osteoporotic vertebral compression fractures (VCF)
Osteoporotic vertebral fractures form a spectrum between the initial often mild endplate fracture progressing to severe collapse and vertebra plana (VP) with or without spinal angulation and deformity

Summary

Introduction

Most of the osteoporotic vertebral compression fractures are related to falls or load injuries on an underlying osteoporotic spine in elderly patients. We further sub-divide severe fractures into two groups: high-degree fractures (HDF), defined as fractures with 50-70% collapse; and VP, defined as fractures with greater than 70% collapse. This range of severe vertebral compression fractures are more commonly seen at the thoracolumbar junction, which serves as the fulcrum of thoracolumbar spinal motion, creating biomechanical instability and increasing the risk for progressive collapse even with bracing. It is generally theorized that the greater the percentage of vertebral collapse, the greater the resultant spinal kyphotic angulation, which shifts the center of gravity anteriorly making the patient vulnerable to fracture progression, presenting as worsening collapse, increased kyphosis, higher risk for adjacent level fractures, and predisposing patients to multiple "cascading" fractures [2]

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Discussion

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