The Effect of Early Limited Activity after Bipedicular Percutaneous Vertebroplasty to Treat Acute Painful Osteoporotic Vertebral Compression Fractures

摘要

Background: Although percutaneous vertebroplasty (PVP) can effectively relieve the pain forpatients with acute osteoporotic vertebral compression fractures (OVCFs), many patients stillcomplain of mild back pain in the early postoperative period.Objectives: The aim of this study was to assess the effect of early limited activity (LA) on prognosisafter bipedicular small-cement-volume (i.e., PVP) to treat single-segment acute OVCFs.Study Design: A prospective study and retrospective observations were performed on 125patients with a minimum of 1 year of follow-up.Setting: A university hospital orthopedics and pathology departments.Methods: All patients were allocated into an LA group (n = 64) and an unlimited activity group(ULA group, n = 61). Patients in the LA group were suggested to keep time of off-bed activity< 4 hours per day in the first 3 weeks postoperatively. Patients in the ULA group did not limitactivity. The demographic, clinical, and radiologic outcomes were assessed, such as pain intensityNumeric Rating Scale (NRS-11) and vertebral height ratio (i.e., fractured vertebral height/adjacentnonfractured vertebral height). Based on outcomes following surgery, all patients were classifiedas responders (NRS-11 score 1-day postoperation < 50% of preoperative NRS-11 score) or lowresponders (NRS-11 score 1-day postoperation ≥ 50% of preoperative NRS-11 score).Results: The demographic results and complications were similar. In the LA group, NRS-11scores at 1 and 3 months postoperation respectively were 2.23 ± 0.42 and 1.46 ± 0.40, andcorresponding scores respectively were 2.85 ± 0.80 and 1.73 ± 0.77 in the ULA group, and therewas a difference in the 2 groups in both time points (P < 0.05). At 12 months postoperation,anterior and middle vertebral height ratio respectively were 78.42% ± 3.52% and 82.37% ±3.49% in the LA group, which were higher than 76.87% ± 3.68% and 81.10% ± 3.31% in theULA group (P < 0.05). Thirty-two cases were low responders. Among those, NRS-11 scores at 1and 3 months postoperation respectively were 2.29 ± 0.45 and 1.53 ± 0.46 in the LA group, whichwere lower than 3.67 ± 0.80 and 2.56 ± 0.79 in the ULA group (P < 0.05), and at 12 monthspostoperation, anterior vertebral height ratio was 79.81% ± 3.25% in the LA group and 75.60%± 3.50% in the ULA group (P < 0.05).Limitations: First, some patients lacked the results of bone mineral density during follow-up;second, the limited time in our study was chosen from our previous working experience, whichmay lack an objective basis; third, NRS-11 is solely used as an indicator of clinical outcomes in ourstudy; finally, our next studies can increase the sample size to improve the clinically difference.Conclusions: LA in the early period after PVP can help patients achieve more pain reliefpostoperatively and maintain better vertebral shape, especially for low responders.