Comparison of Outcomes of Conservative Treatment, Early Vertebroplasty, and Delayed Vertebroplasty in Patients with Osteoporotic Vertebral Compression Fractures

Se-Hyuk Im; Young-Joon Ahn; Bo-Kyu Yang; Seung-Rim Yi; Ye-Hyun Lee; Ji-Eun Kwon; Jong-Min Kim

doi:10.4184/jkss.2016.23.3.139

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Im, Ahn, Yang, Yi, Lee, Kwon, and Kim: Comparison of Outcomes of Conservative Treatment, Early Vertebroplasty, and Delayed Vertebroplasty in Patients with Osteoporotic Vertebral Compression Fractures

Original Article

Journal of Korean Spine Surg 2016;23(3):139-145.

Published online: 30 September 2016

DOI: https://doi.org/10.4184/jkss.2016.23.3.139

Comparison of Outcomes of Conservative Treatment, Early Vertebroplasty, and Delayed Vertebroplasty in Patients with Osteoporotic Vertebral Compression Fractures

Se-Hyuk Im, M.D., Young-Joon Ahn, M.D., Bo-Kyu Yang, M.D., Seung-Rim Yi, M.D., Ye-Hyun Lee, M.D., Ji-Eun Kwon, M.D., Jong-Min Kim, M.D.

Department of Orthopeadic Surgery, National Police Hospital, Seoul, Korea

Corresponding author: Young-Joon Ahn, M.D. Department of Orthopeadic Surgery, National Police Hospital, 123, Songi-ro, Songpa-gu, Seoul, 138-708, Korea TEL: +82-2-3400-1252, FAX: +82-2-449-2120 E-mail: osahnyj@lycos.co.kr

Received 23 July 201511 August 2015 Accepted 18 November 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study.

Objectives

To compare the treatment outcomes of conservative treatment, early vertebroplasty (EVP), and delayed VP (DVP) of patients with osteoporotic compression fractures.

Summary of Literature Review

VP is regarded as an effective treatment for osteoporotic compression fractures. Few studies have compared the outcomes of each of the following treatments: conservative treatment, EVP, and DVP.

Materials and Methods

A total of 202 patients who presented with thoracolumbar osteoporotic vertebral compression fractures between January 2008 and December 2013 were divided into three groups: group 1 (conservative treatment), group 2 (VP within three weeks), and group 3 (VP after three weeks). We compared the collapse rate and the visual analog scale (VAS) score immediately after the trauma and at the 1-week, 3-week, 6-week, and 1-year follow-ups.

Results

The three abovementioned groups consisted of 89 patients, 60 patients, and 53 patients, respectively. The bone mass density (BMD) score of group 1 was statistically significantly higher than that of the others (p<0.05). In group 2, the average VAS score was high immediately after the trauma and low at the 1-year follow-up. Only group 2 showed a significantly high vertebral compression rate immediately after the trauma (p<0.05). Although there were no statistically significant differences in the incidence between the adjacent and the non-adjacent vertebral compression fractures, more patients underwent additional VP in groups 2 and 3 (p= 0.980).

Conclusion

The treatment method of performing EVP seems to yield the best clinical outcomes for patients with osteoporotic compression fractures who exhibit a relatively low BMD, high collapse rate, and high VAS score. Conservative management is the treatment of choice for osteoporotic compression fracture patients with a relatively high BMD, low collapse rate, and low VAS score.

Keywords: Fractures, Compression, Osteoporosis, Vertebroplasty

REFERENCES

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Table 1.

Summary of demographic in the three groups

	Group 1	Group 2	Group 3
No. Patients	89	60	53
Age(yr)	69.2±12.6	78.1±7.2	74.9±6.7
Female's ratio(%)	73.0	83.3	90.6
Location of fractures
T10	9	10	8
T11	11	13	17
T12	25	27	23
L1	28	27	34
L2	20	22	11
L3	7	2	8

Table 2.

Comparison of VAS score in the three groups

	Initial	PAD 1week	PAD 3week	PAD 6week	1 year
Group 1	5.2±1.1^C	4.4±1.0^B	4.0±0.9^A	3.7±1.1^A	2.3±0.7^A
Group 2	6.1±1.0^A	3.0±0.9^C	2.5±0.8^C	2.1±0.8^C	1.4±0.6^C
Group 3	5.6±0.7 ^B	4.8±0.8 ^A	3.2±0.8 ^B	2.8±0.6 ^B	1.9±0.6 ^B
^∗P value	< 0.05	< 0.05	< 0.05	< 0.05	< 0.05

All presenting results demonstrate mean± SD. PAD, post-accident day.

^∗ indicates statistical analysis using Dunnett post-hoc analysis.

^A,B,C Different characters mean significant difference between groups.

Table 3.

Compression ratio of anterior parts of vertebral body in the three groups

	Initial	PAD 1week	PAD 3week	PAD 6week	1 year
Group 1	14.54±9.03^B	22.16±11.52^B	24.45±12.57^B	34.95±12.31^A	42.38±11.83^A
Group 2	26.19±11.26^A	3.55±12.77^C	5.86±11.81^C	8.77±12.04^B	16.20±10.71^C
Group 3	17.60±15.45^B	27.21±14.71^A	32.64±14.85^A	8.62±10.48^B	21.37±14.67^B
^∗P value	< 0.05	< 0.05	< 0.05	< 0.05	< 0.05

All presenting results demonstrate mean± SD. PAD, post-accident day.

^∗ indicates statistical analysis using Dunnett post-hoc analysis.

^A,B,C Different characters mean significant difference between groups.

Table 4.

Adjacent and non-adjacent vertebral fractures in the three groups

	Adjacent fracture	Non-adjacent fracture	Total	Additional Vertebroplasty	p-value
Group 1	12(13.5%)	6(6.7%)	18(20.2%)	4/18(22.2%)
Group 2	8(13.3%)	5(8.3%)	13(21.7%)	9/13(69.2%)	p=0.980
Group 3	8(15.1%)	3(5.7%)	11(20.8%)	9/11(81.8%)

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