Vertebroplasty versus conservative treatment for severe thoracolumbar wedge-shaped osteoporotic vertebral compression fractures

Abstract

Objective To compare the clinical outcomes of percutaneous vertebroplasty (PVP) and conservative treatment for patients with severe thoracolumbar wedge-shaped osteoporotic vertebral compression fracture (OVCF).Methods From January 2007 to January 2010,a total of 43 patients with severe thoracolumbar wedge-shaped OVCF were nonrandomly assigned to undergo PVP (19 cases) or conservative treatment (24 cases) according to their own will.The baseline clinical and radiological characteristics in both groups were comparable.Clinical outcomes were determined by pain visual analogue scale(VAS) and short form 36 health survey(SF-36).Vertebral height,kyphotic angle and cement leakage were assessed by radiography while new OVCFs by MRI.Results All the 43 patients obtained a follow-up of at least one year.The PVP group vas significantly superior to the conservative group regarding VAS score,physical component summary (PCS) score,anterior and central vertebral heights and kyphotic angle at all postoperative intervals( P ＜ 0.05),while no significant differences were found between the 2 groups regarding posterior vertebral height,new OVCF incidence or mental component summary (MCS) score at all postoperative intervals( P ＞ 0.05) except for the first month after treatment.New OVCFs were found 53 days earlier in the PVP group than in the conservative group,with a significant difference( P ＜ 0.05).Asymptomatic cement leakage occurred in 52.6％ (10/19) of the treated vertebrae in PVP group and 70.0％ of them (7/10) occurred in the intervertebral disc.Conclusions PVP is technically feasible for treatment of severe thoracolumbar wedge-shaped OVCF in spite of a high rate of asymptomatic leakage.PVP may lead to immediate and sustained pain relief and physical functional improvement,without increasing the risk of new OVCFs,which are significantly greater than what can be achieved by the conservative treatment. Key words: Spinal fractures; Osteoporosis; Vertebroplasty