Chronic Painful Osteoporotic Vertebral Compression Fractures of Thoracolumbar Spine: Percutaneous Vertebroplasty versus Conservative Management among Egyptian Patients

摘要

Background Data: Vertebral augmentation procedures are widely used today in treating acute and subacute osteoporotic vertebral compression fractures (OVCFs). However, percutaneous vertebroplasty for patients with chronic painful OVCFs has been less well studied. Study Design: A prospective cohort study. Purpose: to compare the efficacy and safety of percutaneous vertebroplasty with conservative treatment for management of chronic painful OVCFs in thethoracolumbar spine among Egyptian patients. Patients and Methods: Ninety-eight patients presented with acute OVCFs during the period from October 2009 to December 2013. They were treated conservatively and followed for at least 3 months. Thereafter, 38 patients were excluded from this study as significant pain improvement was noticed in 32 patients and 6 didn't fulfill the inclusion criteria of this study. The remaining 60 patients (38 females and 22 males, mean age: 65.42±8.63) with chronic painful OVCFs were included in this prospective cohort study. Twenty-eight patients were treated with percutaneous vertebroplasty (Vertebroplasty group). Thirty two patients refused surgical treatment and constituted the control group (Conservative group). All patients were evaluated with X-rays and CT scan, where Cobb angle and the anteroposterior height comparison (APHC) were measured. Overall pain and quality of life were assessed with the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) respectively.Results: All patients were followed for at least 12 months. Statistical analysis of the demographic data of the two groups could not reveal any significant differences. At latest follow up, there was significant improvement in Cobb angle and APHC in Vertebroplasty group when compared with Conservative group (P=0.001). Three patients in the Conservative group (9.37%) went into nonunion, while all patients in the Vertebroplasty group showed radiological evidence of good stability at latest follow up. A significant improvement of VAS Scores (P=0.001) and ODI (P=0.001) was observed in theVertebroplasty group when compared to the Conservative group at the latest follow up. Conclusion: Percutaneous vertebroplasty is safe and effective in treatment of chronic painful osteoporotic vertebral compression fractures with significantly better radiological and clinical outcomes when compared with conservative management. (2015ESJ086)