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Chen R, Zhang P, Li K, Liu Q, Li G. Risk factors of costal pain of thoracic osteoporotic vertebral compression fractures: a multicenter retrospective analysis. Sci Rep 2025; 15:10739. [PMID: 40155612 PMCID: PMC11953379 DOI: 10.1038/s41598-025-88920-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Accepted: 01/31/2025] [Indexed: 04/01/2025] Open
Abstract
The phenomenon of costal pain of thoracic osteoporotic vertebral compression fractures (OVCFs) has been reported. However, to our knowledge, few reports with a larger sample size have analyzed the risk factors of costal pain of thoracic OVCFs. The aim of this study is to evaluate the risk factors of the costal pain in thoracic OVCFs patients. A total of 425 consecutive OVCFs patients were included in this retrospective study. Data on the clinical and radiological parameters were obtained and evaluated. Independent t-tests and chi-square tests were used in univariate analysis and multivariate logistic regression analysis was performed for statistically significant variables. P < 0.05 was considered to indicate statistical significance. Ultimately, 67 of 425 OVCFs patients with costal pain of were divided into Group A (costal pain group) and the rest into Group B (non-costal pain group). In the univariate analysis, the risk factors of costal pain of OVCFs included fracture level, TA, ratio of injured vertebral width, and reduction ratio of foraminal area (P < 0.001, P = 0.031, P = 0.003, P < 0.001, respectively). Multivariate logistic regression analysis revealed that independent risk factors of costal pain of thoracic OVCFs were middle thoracic vertebra [odds ratio (OR) = 5.520, P < 0.001], ratio of injured vertebral width [(OR = 76.138, P = 0.025)] and reduction ratio of foraminal area [(OR = 1.019, P = 0.027)]. The independent risk factors of costal pain of thoracic OVCFs were middle thoracic vertebra, ratio of injured vertebral width and reduction ratio of foraminal area.
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Affiliation(s)
- Runsen Chen
- Department of Orthopaedics, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Department of Orthopaedics, Jianyang City People's Hospital, Chengdu, China
| | - Pengxin Zhang
- Department of Spine Surgery, Suining Central Hospital, No. 27 Dongping North Road, Hedong New Area, Suining City, Sichuan Province, 629000, China
| | - Kaifu Li
- Department of Orthopaedics, The First People's Hospital of Mianyang, Mianyang, China
| | - Qiangfu Liu
- Department of Orthopaedics, The Second People's Hospital of Deyang, Deyang, China
| | - Guangzhou Li
- Department of Spine Surgery, Suining Central Hospital, No. 27 Dongping North Road, Hedong New Area, Suining City, Sichuan Province, 629000, China.
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Gozel T, Ortiz AO. Vertebral Augmentation for Osteoporotic Vertebral Compression Fractures: What is the Current Evidence Pro and Con? Radiol Clin North Am 2024; 62:979-991. [PMID: 39393856 DOI: 10.1016/j.rcl.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2024]
Abstract
Osteoporotic vertebral compression fractures can be quite challenging to treat, especially since they often occur in older adults and can be associated with significant morbidity and mortality. The standard treatment for these fractures has been medical management, as many of these patients are not candidates for open surgery. Vertebral augmentation procedures have emerged as another treatment option. Though initially accepted by clinicians, the benefit of these procedures has been questioned by several clinical trials. Safety concerns related to adjacent level fractures and cement extravasation have also been raised. We review these controversies in the context of the current literature.
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Affiliation(s)
- Tarik Gozel
- Department of Radiology, Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Pkwy South, Bronx, NY 10461, USA.
| | - A Orlando Ortiz
- Department of Radiology, Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Pkwy South, Bronx, NY 10461, USA
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Peckham ME, Miller TS, Amrhein TJ, Hirsch JA, Kranz PG. Image-Guided Spine Interventions for Pain: Ongoing Controversies. AJR Am J Roentgenol 2023; 220:736-745. [PMID: 36541595 DOI: 10.2214/ajr.22.28643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An expanding array of image-guided spine interventions have the potential to provide immediate and effective pain relief. Innovations in spine intervention have proceeded rapidly, with clinical adoption of new techniques at times occurring before the development of bodies of evidence to establish efficacy. Although new spine interventions have been evaluated by clinical trials, acceptance of results has been hindered by controversies regarding trial methodology. This article explores controversial aspects of four categories of image-guided interventions for painful conditions: spine interventions for postdural puncture headache resulting from prior lumbar procedures, epidural steroid injections for cervical and lumbar radiculopathy, interventions for facet and sacroiliac joint pain, and vertebral augmentations for compression fractures. For each intervention, we summarize the available literature, with an emphasis on persistent controversies, and discuss how current areas of disagreement and challenge may shape future research and innovation. Despite the ongoing areas of debate regarding various aspects of these procedures, effective treatments continue to emerge and show promise for aiding relief of a range of debilitating conditions.
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Affiliation(s)
- Miriam E Peckham
- Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, 30 N 1900 E, #1A071, Salt Lake City, UT 84132-2140
| | - Todd S Miller
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Timothy J Amrhein
- Department of Radiology, Division of Neuroradiology, Spine Intervention Service, Duke University Medical Center, Durham, NC
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Peter G Kranz
- Department of Radiology, Division of Neuroradiology, Duke University Medical Center, Durham, NC
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Ren H, Feng T, Hu Y, Cao J, Jiao P, Pan S. A Retrospective Study to Evaluate the Role of Dynamic Fracture Mobility in the Conservative Treatment of Osteoporotic Vertebral Compression Fractures. World Neurosurg 2023; 173:e189-e193. [PMID: 36780982 DOI: 10.1016/j.wneu.2023.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To investigate whether dynamic fracture mobility could affect the outcome of conservative treatment in patients with acute osteoporotic vertebral compression fracture (OVCF). METHODS A total of 158 patients who underwent conservative treatment in our hospital for painful OVCFs were included in this study and their data were retrospectively analyzed. According to the degree of pain relief, patients were divided into an excellent efficacy group and a poor efficacy group. Factors that may affect the outcome of conservative treatment were recorded for each patient. Variables with a statistical difference between the 2 groups were entered into multivariate logistic regression analysis to identify the factors influencing the outcome of conservative treatment. Receiver operating characteristic curve analysis was also performed. RESULTS The result showed that dynamic fracture mobility, overweight, age, and bone mineral density (BMD) (all P < 0.001) were independent factors influencing the outcome of conservative treatment. Receiver operating characteristic curve analysis showed that the cutoff values for age and BMD that predicted treatment effect were 72.5 years and -3.30, respectively. CONCLUSIONS This study confirmed that dynamic fracture mobility could be used as an independent factor predicting the outcome of conservative treatment in patients with acute OVCFs. It was also shown that overweight, age, and BMD were other independent factors influencing the outcome of conservative treatment. A comprehensive evaluation of these related factors can guide the doctor to take appropriate treatment for a unique acute OCVF.
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Affiliation(s)
- Hu Ren
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Tao Feng
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, China.
| | - Yaning Hu
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Jianhui Cao
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Pan Jiao
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Shuo Pan
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, China
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Javed S, Perry K, Mach S, Huh B. Case report: Use of peripheral nerve stimulation for treatment of pain from vertebral plana fracture. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1088097. [PMID: 36713642 PMCID: PMC9878588 DOI: 10.3389/fpain.2022.1088097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023]
Abstract
Vertebral plana fractures are a severe form of compression fractures that can cause significant morbidity due to incapacitating pain. Due to the flattening of the vertebrae in a plana fracture, accessing the vertebral body transpedicularly can be difficult, making traditional vertebral augmentation treatment dangerous. These injuries also typically occur in elderly patients with contraindications to invasive procedures. Peripheral nerve stimulation is a relatively new and minimally invasive treatment that uses electrical stimulation to inhibit pain signals from reaching the somatosensory cortex. Our case describes an 80 Year old female with multiple comorbidities and refractory pain due to a vertebral planar fracture successfully treated with a 60 day course of peripheral nerve stimulation as evidenced by over 50% reduction in symptoms and discontinuation of opioid pain medication use.
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Affiliation(s)
- Saba Javed
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, United States
| | - Kenneth Perry
- Department of Anesthesiology, Critical Care and Pain Medicine, University of Texas Health Science Center at Houston, Houston, United States,Correspondence: Kenneth Perry
| | - Steven Mach
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, United States
| | - Billy Huh
- Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, United States
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Dang SJ, Wei WB, Wei L, Xu J. Vertebroplasty combined with facet joint block vs. vertebroplasty alone in relieving acute pain of osteoporotic vertebral compression fracture: a randomized controlled clinical trial. BMC Musculoskelet Disord 2022; 23:807. [PMID: 35999526 PMCID: PMC9396809 DOI: 10.1186/s12891-022-05753-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/05/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The study objective was to compare the efficacy and safety of percutaneous vertebroplasty (PVP) combined with facet joint block (FB) and vertebroplasty alone in relieving acute pain on osteoporotic vertebral compression fractures (OVCFs). Methods A prospective, randomized controlled study was conducted. One hundred ninety-eight patients of OVCFs undergoing surgery were randomly divided into two groups: Group P (PVP, n = 97), Group PF (PVP + FB, n = 101). The Visual analogue scale (VAS) and Oswestry disability index (ODI) were measured during pre-operation, 1 day, 1, 3, 6 and 12 months after the operation, respectively. The hospitalization time, operation time, complications, recurrence, the mean amount of cement injected and the number of patients who applied Cox-2 inhibitors within 3 days after operation were compared in the two groups. Results The VAS and ODI scores at each observation point of the post-operation were significantly decreased than that at the pre-operation in both groups (P < 0.05). The VAS and ODI scores in Group PF were significantly lower than that in Group P 1 day and 1 month after the operation (P < 0.05). The number of patients who applied Cox-2 inhibitors within 3 days after operation in group PF was significantly lower that in Group P (P < 0.001). There was no significant difference in hospitalization time, operation time, the mean amount of cement injected, complication rate, VAS and ODI scores at the pre-operation (P > 0.05). Conclusion Both PVP combined with FB and PVP alone are effective treatment methods for OVCFs. But PVP combined with FB showed better back pain relief than PVP alone in the short term after the operation for OVCFs.
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Affiliation(s)
- Sha-Jie Dang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.,Department of Anesthesia, Shaanxi Provincial Cancer Hospital, Xi'an, 710061, China
| | - Wen-Bo Wei
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.,Department of Orthopedics, Shaanxi Provincial people's Hospital, Xi'an, 710068, China
| | - Ling Wei
- Department of Pain, YangLing Demonstration Zone Hospital, Yang ling, 712100, China.
| | - Jin Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.
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Zhang X, Li ZX, Yin LJ, Chen H. Selective nerve block for the treatment of neuralgia in Kummell’s disease: A case report. World J Clin Cases 2022; 10:7523-7530. [PMID: 36158019 PMCID: PMC9353927 DOI: 10.12998/wjcc.v10.i21.7523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/01/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuralgia is frequently noted in patients with Kummell’s disease, and its mechanism is complex, rendering it challenging to treat. Percutaneous kyphoplasty (PKP) has been widely used to treat osteoporotic vertebral compression fractures with satisfactory outcomes. However, it is not optimal for managing severely collapsed vertebrae, as cement injection may not be feasible. This report describes the use of a selective nerve block for the treatment of neuralgia caused by severely collapsed vertebrae in a patient with Kummell’s disease.
CASE SUMMARY In our patient, three vertebrae were involved. The collapse of T11 was particularly severe. After managing T8 and T9 using PKP, these two segments were effectively strengthened; consequently, back pain was significantly relieved. However, the structure and strength of T11 could not be effectively restored using a minimally invasive surgical method because there was little room for cement injection. This caused obvious neuralgia according to the postoperative status of the PKP. Thus, we performed selective nerve blocks for the treatment of neuralgia, which resulted in satisfactory outcomes.
CONCLUSION Selective nerve block may be a possible therapeutic strategy for neuralgia due to severely collapsed vertebrae in Kummell’s disease.
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Affiliation(s)
- Xin Zhang
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Zong-Xi Li
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Li-Jun Yin
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
- Department of Anesthesiology, Ningbo Women and Children’s Hospital, Ningbo 315012, China
| | - Hui Chen
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, shanghai 200434, China
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Chen Z, Song C, Chen J, Sun J, Liu W. Can facet joint block be a complementary or alternative therapeutic option for patients with osteoporotic vertebral fractures: a meta-analysis. J Orthop Surg Res 2022; 17:40. [PMID: 35063004 PMCID: PMC8781236 DOI: 10.1186/s13018-022-02933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Recently facet joint block has been increasingly used to relief the residual pain after vertebral augmentation, but whether it can be a complementary or alternative to vertebral augmentation remain largely unknown. Thus, we conducted this meta-analysis to determine the effect of facet joint block in the treatment of osteoporotic vertebral compression fractures (OVCF).
Methods
Following PRISMA statement, a comprehensive literature search through Embase, PubMed, Web of Science, Wanfang Data, China National Knowledge Infrastructure and Chinese BioMedical Literature Database was performed to identify relevant studies. Studies comparing vertebral augmentation combined with facet joint block (combined therapy) with vertebral augmentation, and studies comparing facet joint block with vertebral augmentation were analyzed, respectively.
Results
A total of 10 studies were included. There were seven studies comparing combined therapy with vertebral augmentation, the results showed combined therapy was associated with significantly lower visual analog scale (VAS) scores on postoperative day 1, 7, month 1, 3, and lower oswestry disability index (ODI) scores on postoperative day 1, 7, and month 3. There were three studies comparing facet joint block with vertebral augmentation, the results demonstrated vertebral augmentation only provided better analgesia in month 1 after surgery, but it was associated with a higher incidence of refracture.
Conclusions
Current evidence suggested facet joint block might be considered as a complementary to vertebral augmentation in the treatment of OVCF, but it might not be effectively used as an alternative therapy.
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Láinez Ramos-Bossini AJ, López Zúñiga D, Ruiz Santiago F. Percutaneous vertebroplasty versus conservative treatment and placebo in osteoporotic vertebral fractures: meta-analysis and critical review of the literature. Eur Radiol 2021; 31:8542-8553. [PMID: 33963449 DOI: 10.1007/s00330-021-08018-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/23/2021] [Accepted: 04/27/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To assess the current evidence regarding the efficacy of percutaneous vertebroplasty (PVP) over conservative treatment (CT) and placebo in osteoporotic vertebral fractures (OVFs) by performing a meta-analysis of randomized controlled trials (RCTs). MATERIALS AND METHODS A systematic search was conducted on PubMed, EMBASE, and Cochrane databases. The main outcomes were pain relief, improvement of functional disability, and quality of life at different time points: short-term (1-2 weeks), medium-term (1-3 months), and long-term (≥ 6 months). Subgroup analyses based on time from fracture onset and sham procedure were also performed. RESULTS A total of 14 RCTs were included in the meta-analysis. PVP showed significant benefits over CT in all outcomes, but slight-to-none clear differences over placebo. Subgroup analyses revealed that PVP performed in fractures < 6 weeks provided superior short-term pain relief than the control group (p = .02), and better quality of life in the medium-term (p = .03) and long-term (p = .006). Placebo based on infiltrating the skin alone was significantly inferior to PVP at most time points in all outcomes, but no significant differences between PVP and placebo were found when the sham procedure consisted of infiltrating both the skin and periosteum. CONCLUSIONS PVP showed significant advantages over CT in terms of efficacy, but benefits were more limited when compared to placebo. In addition, benefits of PVP are more prominent in recent OVFs. Differences in the sham procedure or criteria regarding patient's selection/allocation seem to be the main causes of disparity in previous RCTs. KEY POINTS • Previous RCTs showed significant advantages of PVP over CT in terms of efficacy, but benefits were more limited when compared to placebo. • Differences in patient allocation or in the sham procedure might explain the lack of benefits of PVP versus placebo found in previous RCTs. • Despite controversial opinions, PVP should be offered to patients with OVFs as an alternative option to conservative treatment.
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Affiliation(s)
- A J Láinez Ramos-Bossini
- Department of Radiology, Virgen de las Nieves University Hospital, Fuerzas Armadas Av. 2, 18014, Granada, Spain.
- Department of Radiology, Faculty of Medicine, University of Granada, Granada, Spain.
- Programme in Clinical Medicine and Public Health, University of Granada, Granada, Spain.
| | - D López Zúñiga
- Department of Radiology, Virgen de las Nieves University Hospital, Fuerzas Armadas Av. 2, 18014, Granada, Spain
| | - F Ruiz Santiago
- Department of Radiology, Virgen de las Nieves University Hospital, Fuerzas Armadas Av. 2, 18014, Granada, Spain
- Department of Radiology, Faculty of Medicine, University of Granada, Granada, Spain
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Zuo XH, Chen YB, Xie P, Zhang WD, Xue XY, Zhang QX, Shan B, Zhang XB, Bao HG, Si YN. Finite element analysis of wedge and biconcave deformity in four different height restoration after augmentation of osteoporotic vertebral compression fractures. J Orthop Surg Res 2021; 16:138. [PMID: 33588890 PMCID: PMC7885256 DOI: 10.1186/s13018-021-02225-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Biomechanical comparison of wedge and biconcave deformity of different height restoration after augmentation of osteoporotic vertebral compression fractures was analyzed by three-dimensional finite element analysis (FEA). Methods Three-dimensional finite element model (FEM) of T11-L2 segment was constructed from CT scan of elderly osteoporosis patient. The von Mises stresses of vertebrae, intervertebral disc, facet joints, displacement, and range of motion (ROM) of wedge and biconcave deformity were compared at four different heights (Genant 0–3 grade) after T12 vertebral augmentation. Results In wedge deformity, the stress of T12 decreased as the vertebral height in neutral position, flexion, extension, and left axial rotation, whereas increased sharply in bending at Genant 0; L1 and L2 decreased in all positions excluding flexion of L2, and T11 increased in neutral position, flexion, extension, and right axial rotation at Genant 0. No significant changes in biconcave deformity. The stress of T11-T12, T12-L1, and L1-L2 intervertebral disc gradually increased or decreased under other positions in wedge fracture, whereas L1-L2 no significant change in biconcave fracture. The utmost overall facet joint stress is at Genant 3, whereas there is no significant change under the same position in biconcave fracture. The displacement and ROM of the wedge fracture had ups and downs, while a decline in all positions excluding extension in biconcave fracture. Conclusions The vertebral restoration height after augmentation to Genant 0 affects the von Mises stress, displacement, and ROM in wedge deformity, which may increase the risk of fracture, whereas restored or not in biconcave deformity.
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Affiliation(s)
- Xiao-Hua Zuo
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.,Department of Pain Management, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Yin-Bing Chen
- Department of Orthopedic Surgery, The Affiliated Haian Hospital of Nantong University, Haian, 226600, China
| | - Peng Xie
- Department of Neurosurgery, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Wen-Dong Zhang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Xiang-Yun Xue
- Department of Pain Management, Yancheng No.1 People's Hospital, Yancheng, 224000, China
| | - Qian-Xi Zhang
- Department of Pain Management, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Ben Shan
- Department of Radiology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Xiao-Bing Zhang
- Department of Radiology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China.
| | - Hong-Guang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Yan-Na Si
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
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Percutaneous Vertebroplasty and Facet Blocking for Treating Back Pain Caused by Osteoporotic Vertebral Compression Fracture. Pain Res Manag 2020; 2020:5825317. [PMID: 32849933 PMCID: PMC7441434 DOI: 10.1155/2020/5825317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/21/2020] [Accepted: 07/28/2020] [Indexed: 11/18/2022]
Abstract
Methods Clinical and radiological data of 204 patients were reviewed. The patients were divided into Group A (PVP alone) and Group B (PVP and FB combined therapy) according to treatments. Back pain was evaluated with Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). The operation, fluoroscopic exposure time, and bone cement leakage were recorded. The χ2 test, Student's t-test, and repeated measures analysis of variance were used to compare the differences between the two groups. Results There were 125 patients in Group A and 79 patients in Group B. Their baseline characteristics were similar (P > 0.05). The mean VAS scores of Group A and Group B were 7.03 and 7.21 at admission, 4.7 and 3.2 at 1 day after operation, 4.0 and 3.0 at 3 months, and 2.2 and 2.2 at 12 months after operation, respectively. The mean ODI scores of Group A and Group B were 30.9 and 29.8 at admission, 17.6 and 17.7 at 3 months, and 10.5 and 10.9 at 12 months after operation, respectively. The mean operation time and fluoroscopic exposure time of Group A (35.6 minutes and 7.2 seconds, respectively) was significantly shorter than that of Group B (45.7 minutes and 11.7 seconds, respectively, P < 0.01). The incidence of bone cement leakage and new fractures after operation did not have statistically significant difference between groups. Conclusion PVP and FB combined therapy could provide better pain relief than PVP alone in short term after operation in patients with OVCFs associated back pains.
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12
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Beall D. Response to: The evidentiary basis of vertebral augmentation: a 2019 update. J Neurointerv Surg 2020; 12:439-440. [DOI: 10.1136/neurintsurg-2019-015507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 01/05/2023]
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13
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Clinical and imaging characteristics of patients with extreme low back pain or sciatica referred for spinal injection. Neuroradiology 2019; 61:881-889. [PMID: 31101947 DOI: 10.1007/s00234-019-02222-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/06/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE To analyze the causes of pain, imaging characteristics, and therapeutic effect of spinal injection in patients with extreme low back pain or sciatica. METHODS We analyzed 381 consecutive patients with extreme low back pain or sciatica visiting our spinal intervention center between January and December 2017. Clinical and imaging characteristics were analyzed. The treatment response, defined as a numerical pain rating scale decrease of ≥ 30%, was measured. Fisher's exact test was performed to identify the association between the injection response and subsequent lumbar surgery rate. RESULTS The most frequent cause of pain was spinal stenosis, followed by herniated intervertebral disc, facet osteoarthritis, and osteoporotic compression fracture. A herniated intervertebral disc was the most common disorder in patients < 50 years of age, while spinal stenosis was the most common in patients ≥ 50 years of age. Women comprised 66.4% of the study population. The majority of lumbar pathologies occurred below L3/4. Spinal injection was found to be effective in 44.2% of cases. Those who responded to the injection showed a significantly lower rate of lumbar surgery within 6 months (P = 0.004). CONCLUSIONS Those with extreme low back pain or sciatica had clinical and imaging characteristics similar to those with typical low back pain referred for spinal injection. Spinal injection could be an effective method of pain control for patients with extreme low back pain or sciatica.
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Cawley DT, Butler JS, Benton A, Altaf F, Rezajooi K, Kyriakou C, Selvadurai S, Molloy S. Managing the cervical spine in multiple myeloma patients. Hematol Oncol 2018; 37:129-135. [PMID: 30334279 DOI: 10.1002/hon.2564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/15/2018] [Indexed: 12/12/2022]
Abstract
Discuss the relevant literature on surgical and nonsurgical treatments for multiple myeloma (MM) and their complementary effects on overall treatment. Existing surgical algorithms designed for neoplasia of the spine may not suit the management of spinal myeloma. Less than a fifth of metastatic, including myelomatous lesions, occur in the cervical spine but have a poorer prognosis and surgery in this area carries a higher morbidity. With the advances of chemotherapy, early access to radiotherapy, early orthosis management, and high definition imaging, including CT and MRI, surgical indications in MM have changed. Medical decompression (or oncolysis), including in the presence of neurological deficit and orthotic stabilization, are proving viable nonsurgical options to manage MM. A key to decision making is the assessment and monitoring of biomechanical spinal stability as part of a multidisciplinary approach.
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Affiliation(s)
- Derek T Cawley
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Joseph S Butler
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Adam Benton
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Farhaan Altaf
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Kia Rezajooi
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Charalampia Kyriakou
- Department of Haematology, University College London & London North West Healthcare NHS Trust, London, UK
| | - Susanne Selvadurai
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Sean Molloy
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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15
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Bousson V, Hamze B, Odri G, Funck-Brentano T, Orcel P, Laredo JD. Percutaneous Vertebral Augmentation Techniques in Osteoporotic and Traumatic Fractures. Semin Intervent Radiol 2018; 35:309-323. [PMID: 30402014 DOI: 10.1055/s-0038-1673639] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Percutaneous vertebral augmentation/consolidation techniques are varied. These are vertebroplasty, kyphoplasty, and several methods with percutaneous introduction of an implant (associated or not with cement injection). They are proposed in painful osteoporotic vertebral fractures and traumatic fractures. The objectives are to consolidate the fracture and, if possible, to restore the height of the vertebral body to reduce vertebral and regional kyphosis. Stabilization of the fracture leads to a reduction in pain and thus restores the spinal support function as quickly as possible, which is particularly important in the elderly. The effectiveness of these interventions on fracture pain was challenged once by two randomized trials comparing vertebroplasty to a sham intervention. Since then, many other randomized studies in support of vertebroplasty efficacy have been published. International recommendations reserve vertebroplasty for medical treatment failures on pain, but earlier positioning may be debatable if the objective is to limit kyphotic deformity or even reexpand the vertebral body. Recent data suggest that in osteoporotic fracture, the degree of kyphosis reduction achieved by kyphoplasty and percutaneous implant techniques, compared with vertebroplasty, is not sufficient to justify the additional cost and the use of a somewhat longer and traumatic procedure. In young patients with acute traumatic fractures and a significant kyphotic angle, kyphoplasty and percutaneous implant techniques are preferred to vertebroplasty, as in these cases a deformity reduction has a significant positive impact on the clinical outcome.
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Affiliation(s)
- Valérie Bousson
- Service de Radiologie Ostéoarticulaire, Viscérale et Vasculaire, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Bassam Hamze
- Service de Radiologie Ostéoarticulaire, Viscérale et Vasculaire, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Guillaume Odri
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Thomas Funck-Brentano
- Service de Rhumatologie, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Philippe Orcel
- Service de Rhumatologie, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
| | - Jean-Denis Laredo
- Service de Radiologie Ostéoarticulaire, Viscérale et Vasculaire, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France
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Niu J, Song D, Gan M, Liu B, Tan C, Yang H, Meng B. Percutaneous kyphoplasty for the treatment of distal lumbosacral pain caused by osteoporotic thoracolumbar vertebral fracture. Acta Radiol 2018; 59:1351-1357. [PMID: 29482346 DOI: 10.1177/0284185118761204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Kyphoplasty has been demonstrated to be minimally invasive and effective in treating osteoporotic vertebral fracture patients with back pain over the level of the fractured vertebrae. Rare studies have reported on thoracolumbar vertebral fracture patients presenting with distal lumbosacral pain (DLP). Whether kyphoplasty had a favorable therapeutic benefit for these patients remains unclear. Purpose To evaluate the therapeutic efficacy of kyphoplasty in treating osteoporotic thoracolumbar vertebral fracture (OTVF) patients with DLP and assess the clinical significance of focal tenderness to palpation in these patients. Material and Methods Thirty-two OTVF patients who only complained of DLP were treated by kyphoplasty. The vertebral heights, local kyphotic angle, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) scores were assessed preoperatively, one day after surgery, and at last follow-up. All patients were evaluated regarding their degree of satisfaction with kyphoplasty. In addition, we compared the therapeutic efficacy of kyphoplasty in patients with and without focal tenderness to palpation. Results All patients successfully underwent kyphoplasty without complications. The vertebral heights, local kyphotic angles, VAS, and ODI scores were all significantly improved after kyphoplasty and maintained at last follow-up in our patients ( P < 0.001). At last follow-up, all patients expressed satisfaction with kyphoplasty. No significant differences in these parameters were detected between patients with and without focal tenderness. Conclusion The possibility of thoracolumbar vertebral fractures in elderly patients complaining of DLP should not be neglected. Kyphoplasty presents a superior benefit in treating OTVF patients with DLP. The absence of focal tenderness does not influence the clinical efficacy in these patients.
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Affiliation(s)
- Junjie Niu
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Dawei Song
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Minfeng Gan
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Bin Liu
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Chenglong Tan
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Huilin Yang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Bin Meng
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
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Zuo XH, Zhu XP, Bao HG, Xu CJ, Chen H, Gao XZ, Zhang QX. Network meta-analysis of percutaneous vertebroplasty, percutaneous kyphoplasty, nerve block, and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects. Medicine (Baltimore) 2018; 97:e11544. [PMID: 30024546 PMCID: PMC6086478 DOI: 10.1097/md.0000000000011544] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/21/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Osteoporotic vertebral compression fractures (OVCFs) commonly afflicts most aged people resulting back pain, substantial vertebral deformity, functional disability, decreased quality of life, and increased adjacent spinal fractures and mortality. Percutaneous vertebral augmentation (PVA) included percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP), nerve block (NB), and conservative treatment (CT) are used for the nonsurgery treatment strategy of OVCFs, however, current evaluation of their efficacy remains controversial. METHODS AND ANALYSIS A systematic literature search was carried out in PubMed, EMBASE, Web of Knowledge, and the Cochrane Central Register of Controlled Trials up to October 31, 2017. Randomized controlled trials (RCTs) were compared PVP, PKP, NB, or CT for treating OVCFs. The risk of bias for each trial was rated according to the Cochrane Handbook. Mean differences (MDs) with 95% confidence intervals (CIs) were utilized to express VAS (visual analog scale) outcomes. The network meta-analysis (NMA) of the comparative efficacy measured by change of VAS on acute/subacute and chronic OVCFs was conducted for a short-term (<4 weeks) and long-term (≥6-12months) follow-up with the ADDIS software. RESULTS A total of 18 trials among 1994 patients were included in the NMA. The PVA (PVP and PKP) had better efficacy than CT. PKP was first option in alleviating pain in the case of the acute/subacute OVCFs for long term, and chronic OVCFs for short term and long term, while PVP had the most superiority in the case of the acute/subacute OVCFs for short term. NB ranks higher probability than PKP and PVP on acute/subacute OVCFs in short and long-term, respectively. CONCLUSIONS The present results suggest that PVA (PVP/PKP) had better performance than CT in alleviating acute/subacute and chronic OVCFs pain for short and long-term. NB may be used as an alternative or before PVA, as far as pain relief is concerned. Various nonsurgery treatments including CT, PVA (PVP/PKP), NB, or a combination of these treatments are performed with the goal of reducing pain, stabilizing the vertebrae, and restoring mobility.
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Affiliation(s)
- Xiao-Hua Zuo
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing
- Department of Pain Management, Huai’an Hospital Affiliated to Xuzhou Medical University, Second People's Hospital of Huai’an City, Huai’an, Jiangsu, China
| | - Xue-Piao Zhu
- Department of Pain Management, Huai’an Hospital Affiliated to Xuzhou Medical University, Second People's Hospital of Huai’an City, Huai’an, Jiangsu, China
| | - Hong-Guang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Chen-Jie Xu
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Hao Chen
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Xian-Zhong Gao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Qian-Xi Zhang
- Department of Pain Management, Huai’an Hospital Affiliated to Xuzhou Medical University, Second People's Hospital of Huai’an City, Huai’an, Jiangsu, China
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Chandra RV, Maingard J, Asadi H, Slater LA, Mazwi TL, Marcia S, Barr J, Hirsch JA. Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Fractures: What Are the Latest Data? AJNR Am J Neuroradiol 2018; 39:798-806. [PMID: 29170272 DOI: 10.3174/ajnr.a5458] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Osteoporotic vertebral compression fractures frequently result in significant morbidity and health care resource use. For patients with severe and disabling pain, vertebral augmentation (vertebroplasty and kyphoplasty) is often considered. Although vertebroplasty was introduced >30 years ago, there are conflicting opinions regarding the role of these procedures in the treatment of osteoporotic vertebral compression fractures. This review article updates clinicians on the published prospective randomized controlled data, including the most recent positive trials that followed initial negative trials in 2009. Analysis of multiple national claim datasets has also provided further insight into the utility of these procedures. Finally, we considered the recent recommendations of national organizations and medical societies that advise on the use of vertebral augmentation procedures for osteoporotic vertebral compression fractures.
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Affiliation(s)
- R V Chandra
- From the Interventional Neuroradiology Unit (R.V.C., H.A., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences (R.V.C., L.-A.S.), Monash University, Melbourne, Victoria, Australia
| | - J Maingard
- Interventional Neuroradiology Service (J.M., H.A.), Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - H Asadi
- From the Interventional Neuroradiology Unit (R.V.C., H.A., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Victoria, Australia
- Interventional Neuroradiology Service (J.M., H.A.), Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
- School of Medicine, Faculty of Health (H.A.), Deakin University, Waurn Ponds, Victoria, Australia
| | - L-A Slater
- From the Interventional Neuroradiology Unit (R.V.C., H.A., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences (R.V.C., L.-A.S.), Monash University, Melbourne, Victoria, Australia
| | - T-L Mazwi
- Neuroendovascular Program (T.-L.M., J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S Marcia
- Department of Radiology (S.M.), SS. Trinità Hospital, Cagliari, Italy
| | - J Barr
- Interventional Neuroradiology (J.B.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - J A Hirsch
- Neuroendovascular Program (T.-L.M., J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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19
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Medial branch nerve block and ablation as a novel approach to pain related to vertebral compression fracture. Curr Opin Anaesthesiol 2018; 29:596-9. [PMID: 27548307 DOI: 10.1097/aco.0000000000000375] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review offers a critical examination of the biomechanical model that posits the posterior elements as a substantial contributor to pain in vertebral fracture. Further, the review assesses the treatment of posterior-element-associated pain in the setting of vertebral compression fracture in relation to vertebral augmentation. RECENT FINDINGS In 2015, the only prospective randomized trial comparing percutaneous vertebroplasty with facet blockade was published in which authors found that percutaneous vertebroplasty produced better pain relief and function based on Oswestry Disability Index, Roland Morris Disability Questionnaire, and visual analog scale in the short term (≤1 week). However, differences in pain relief at 1 month and 12 months were not statistically significant. SUMMARY The posterior elements may play a significant role in the pain generated after vertebral compression fractures. Treatment of the posterior element pain through medial branch radiofrequency ablation or facet injections may be another tool in providing analgesia in those with pain after vertebral compression fractures.
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20
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Ong KL, Beall DP, Frohbergh M, Lau E, Hirsch JA. Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty "sham" trials? Osteoporos Int 2018; 29:375-383. [PMID: 29063215 PMCID: PMC6394540 DOI: 10.1007/s00198-017-4281-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/17/2017] [Indexed: 12/24/2022]
Abstract
UNLABELLED The 5-year period following 2009 saw a steep reduction in vertebral augmentation volume and was associated with elevated mortality risk in vertebral compression fracture (VCF) patients. The risk of mortality following a VCF diagnosis was 85.1% at 10 years and was found to be lower for balloon kyphoplasty (BKP) and vertebroplasty (VP) patients. INTRODUCTION BKP and VP are associated with lower mortality risks than non-surgical management (NSM) of VCF. VP versus sham trials published in 2009 sparked controversy over its effectiveness, leading to diminished referral volumes. We hypothesized that lower BKP/VP utilization would lead to a greater mortality risk for VCF patients. METHODS BKP/VP utilization was evaluated for VCF patients in the 100% US Medicare data set (2005-2014). Survival and morbidity were analyzed by the Kaplan-Meier method and compared between NSM, BKP, and VP using Cox regression with adjustment by propensity score and various factors. RESULTS The cohort included 261,756 BKP (12.6%) and 117,232 VP (5.6%) patients, comprising 20% of the VCF patient population in 2005, peaking at 24% in 2007-2008, and declining to 14% in 2014. The propensity-adjusted mortality risk for VCF patients was 4% (95% CI, 3-4%; p < 0.001) greater in 2010-2014 versus 2005-2009. The 10-year risk of mortality for the overall cohort was 85.1%. BKP and VP cohorts had a 19% (95% CI, 19-19%; p < 0.001) and 7% (95% CI, 7-8%; p < 0.001) lower propensity-adjusted 10-year mortality risk than the NSM cohort, respectively. The BKP cohort had a 13% (95% CI, 12-13%; p < 0.001) lower propensity-adjusted 10-year mortality risk than the VP cohort. CONCLUSIONS Changes in treatment patterns following the 2009 VP publications led to fewer augmentation procedures. In turn, the 5-year period following 2009 was associated with elevated mortality risk in VCF patients. This provides insight into the implications of treatment pattern changes and associated mortality risks.
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Affiliation(s)
- K L Ong
- Exponent, Inc., 3440 Market St, Suite 600, Philadelphia, PA, USA.
| | | | - M Frohbergh
- Exponent, Inc., 3440 Market St, Suite 600, Philadelphia, PA, USA
| | - E Lau
- Exponent, Inc., Menlo Park, CA, USA
| | - J A Hirsch
- Massachusetts General Hospital, Boston, MA, USA
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21
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Andrei D, Popa I, Brad S, Iancu A, Oprea M, Vasilian C, Poenaru DV. The variability of vertebral body volume and pain associated with osteoporotic vertebral fractures: conservative treatment versus percutaneous transpedicular vertebroplasty. INTERNATIONAL ORTHOPAEDICS 2017; 41:963-968. [DOI: 10.1007/s00264-017-3409-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/16/2017] [Indexed: 11/29/2022]
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Affiliation(s)
- Joshua A Hirsch
- Neuroendovascular Program and NeuroInterventional Spine Service, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Ronil V Chandra
- Diagnostic and Interventional Neuroradiology, Monash Imaging, Monash Health, Melbourne, VIC, Australia; Departments of Medicine and Surgery, Monash University, Melbourne, VIC, Australia
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Clark W, Bird P, Gonski P, Diamond TH, Smerdely P, McNeil HP, Schlaphoff G, Bryant C, Barnes E, Gebski V. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016; 388:1408-1416. [PMID: 27544377 DOI: 10.1016/s0140-6736(16)31341-1] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/24/2016] [Accepted: 07/28/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND We hypothesised that vertebroplasty provides effective analgesia for patients with poorly controlled pain and osteoporotic spinal fractures of less than 6 weeks' duration. The effectiveness of vertebroplasty, using an adequate vertebral fill technique, in fractures of less than 6 weeks' duration has not been specifically assessed by previously published masked trials. METHODS This was a multicentre, randomised, double-blind, placebo-controlled trial of vertebroplasty in four hospitals in Sydney, Australia. We recruited patients with one or two osteoporotic vertebral fractures of less than 6 weeks' duration and Numeric Rated Scale (NRS) back pain greater than or equal to 7 out of 10. We used an automated telephone randomisation service provided by the National Health and Medical Research Council to assign patients (1:1; stratified according to age, degree of vertebral compression, trauma, corticosteroid use, and hospital) to either vertebroplasty or placebo, immediately before the procedure. Patients received conscious sedation. Vertebroplasty was done with the adequate vertebral fill technique and the placebo procedure with simulated vertebroplasty. Follow-up was for 6 months. Outcome assessors and patients were masked to treatment allocation. The primary outcome was the proportion of patients with NRS pain below 4 out of 10 at 14 days post-intervention in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01482793. FINDINGS Between Nov 4, 2011, and Dec 5, 2014, 120 patients were enrolled. 61 patients were randomly assigned to vertebroplasty and 59 to placebo. 24 (44%) patients in the vertebroplasty group and 12 (21%) in the control group had an NRS pain score below 4 out of 10 at 14 days (between-group difference 23 percentage points, 95% CI 6-39; p=0·011). Three patients in each group died from causes judged unrelated to the procedure. There were two serious adverse events in each group, related to the procedure (vertebroplasty group) and the fracture (control group). INTERPRETATION Vertebroplasty is superior to placebo intervention for pain reduction in patients with acute osteoporotic spinal fractures of less than 6 weeks' in duration. These findings will allow patients with acute painful fractures to have an additional means of pain management that is known to be effective. FUNDING Education grant from CareFusion Corporation.
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Affiliation(s)
- William Clark
- Department of Radiology, St George Private Hospital, Kogarah, NSW, Australia.
| | - Paul Bird
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Peter Gonski
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Aged Care, Sutherland Hospital, Caringbah, NSW, Australia
| | - Terrence H Diamond
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia; Department of Endocrinology, St George Hospital, Kogarah, NSW, Australia
| | - Peter Smerdely
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Aged Care, St George Hospital, Kogarah, NSW, Australia
| | - H Patrick McNeil
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Glen Schlaphoff
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; Department of Interventional Radiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Carl Bryant
- Department of Radiology, St George Private Hospital, Kogarah, NSW, Australia
| | - Elizabeth Barnes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
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Zhao G, Liu X, Li F. Balloon kyphoplasty versus percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures (OVCFs). Osteoporos Int 2016; 27:2823-2834. [PMID: 27121344 DOI: 10.1007/s00198-016-3610-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 04/18/2016] [Indexed: 12/16/2022]
Abstract
UNLABELLED The study investigated whether kyphoplasty (KP) was superior to vertebroplasty (VP) in treating patients with osteoporotic vertebral compression fractures (OVCFs). KP may be superior to VP for treating patients with OVCFs based on long-term VAS and ODI but not short-term VAS. Further large-scale trials are needed to verify these findings due to potential risk of selection bias. INTRODUCTION This study aimed to assess whether KP was superior to VP in treating patients with OVCFs. METHODS The Medline, Embase, and Cochrane databases and references within articles and proceedings of major meetings were systematically searched. Eligible studies included patients with OVCFs who received either KP or VP. Standard mean differences (SMDs) and relative risks (RRs) were used as measures of efficacy and safety in a random-effects model. RESULTS Eleven studies enrolling 869 patients with OVCFs were identified as eligible for final analysis. Compared with VP, KP was associated with significant improvements in long-term (SMD, -0.70; 95 % confidence interval [CI]: -1.30, -0.10; P = 0.023) visual analog scale (VAS); short-term (SMD, -1.50; 95 % CI: -2.94, -0.07; P = 0.040) and long-term (SMD, -1.03; 95 % CI: -1.88, -0.18; P = 0.017) Oswestry Disability Indexes (ODIs); short-term (SMD, -0.74; 95 % CI: -1.42, -0.06; P = 0.032) and long-term (SMD, -0.71; 95 % CI: -1.19, -0.23; P = 0.004) kyphosis angles; and vertebral body height (SMD, 1.56; 95 % CI: 0.62, 2.49; P = 0.001) and anterior vertebral body height (SMD, 3.04; 95 % CI: 0.53, 5.56; P = 0.018). KP was also associated with a significantly longer operation time (SMD, 0.73; 95 % CI: 0.26, 1.19; P = 0.002) and a lower risk of cement extravasation (RR, 0.68; 95 % CI: 0.48, 0.96; P = 0.030) compared with VP. No significant differences were found in the short-term VAS, posterior vertebral body height, and adjacent-level fractures. CONCLUSION Acknowledging some risk of selection bias, KP displayed a significantly better performance compared with VP only in one of the two primary endpoints, that is, for ODI but not for short-term VAS. Further randomized studies are required to confirm these results.
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Affiliation(s)
- G Zhao
- Department of Orthopedics, the Beijing Army General Hospital, No. 5, Nanmengcang Lane, Beijing, 100700, People's Republic of China.
| | - X Liu
- Department of Orthopedics, the Beijing Army General Hospital, No. 5, Nanmengcang Lane, Beijing, 100700, People's Republic of China
| | - F Li
- Department of Orthopedics, the Beijing Army General Hospital, No. 5, Nanmengcang Lane, Beijing, 100700, People's Republic of China
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Im TS, Lee JW, Lee E, Kang Y, Ahn JM, Kang HS. Effects of Facet Joint Injection Reducing the Need for Percutaneous Vertebroplasty in Vertebral Compression Fractures. Cardiovasc Intervent Radiol 2015; 39:740-745. [DOI: 10.1007/s00270-015-1286-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/10/2015] [Indexed: 11/30/2022]
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Molloy S, Lai M, Pratt G, Ramasamy K, Wilson D, Quraishi N, Auger M, Cumming D, Punekar M, Quinn M, Ademonkun D, Willis F, Tighe J, Cook G, Stirling A, Bishop T, Williams C, Boszczyk B, Reynolds J, Grainger M, Craig N, Hamilton A, Chalmers I, Ahmedzai S, Selvadurai S, Low E, Kyriakou C. Optimizing the management of patients with spinal myeloma disease. Br J Haematol 2015; 171:332-43. [DOI: 10.1111/bjh.13577] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Sean Molloy
- Royal National Orthopaedic Hospital; London UK
| | | | - Guy Pratt
- Department of Haematology; Heart of England NHS Trust Foundation; Birmingham UK
| | - Karthik Ramasamy
- Department of Haematology; Oxford University Hospitals NHS Trusts; Oxford UK
| | - David Wilson
- St Luke's Radiology; St Luke's Hospital; Oxford UK
| | - Nasir Quraishi
- Centre for Spinal Studies and Surgery; Queen's Medical Centre; Nottingham UK
| | - Martin Auger
- Department of Haematology; Norfolk and Norwich University Hospital; Norwich UK
| | - David Cumming
- Trauma and Orthopaedics Department; Ipswich Hospital NHS Trust; Ipswich UK
| | - Maqsood Punekar
- Department of Haematology; Lancashire Teaching Hospitals NHS Foundations Trust; Preston UK
| | - Michael Quinn
- Department of Haematology; Belfast City Hospital; Belfast UK
| | - Debo Ademonkun
- Trauma and Orthopaedics Department; Ipswich Hospital NHS Trust; Ipswich UK
| | - Fenella Willis
- Department of Haematology; St Georges Hospital; London UK
| | - Jane Tighe
- Department of Haematology; Aberdeen Royal Infirmary; Aberdeen UK
| | - Gordon Cook
- St James’ Institute of Oncology; Leeds Teaching Hospitals NHS Trust; Leeds UK
| | | | - Timothy Bishop
- Centre for Clinical Haematology; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - Cathy Williams
- Centre for Clinical Haematology; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - Bronek Boszczyk
- Centre for Spinal Studies and Surgery; Queen's Medical Centre; Nottingham UK
| | - Jeremy Reynolds
- Spinal Unit; Oxford University Hospitals NHS Trust; Oxford UK
| | - Mel Grainger
- Royal Orthopaedic Hospital NHS Foundations Trust; Birmingham UK
| | - Niall Craig
- Orthopaedic Suite; Woodend Hospital; Aberdeen UK
| | - Alastair Hamilton
- Department of Orthopaedic Surgery; Musgrove Park Hospital; Belfast UK
| | - Isobel Chalmers
- Trauma and Orthopaedics Department; Ipswich Hospital NHS Trust; Ipswich UK
| | - Sam Ahmedzai
- Academic Unit of Supportive Care; Department of Oncology; University of Sheffield; Sheffield UK
| | | | | | - Charalampia Kyriakou
- Department of Haematology; Northwick Park Hospital and Department of Haematology and Stem Cell Transplantation; Royal Free Hospital; London UK
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27
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Borgström F, Beall DP, Berven S, Boonen S, Christie S, Kallmes DF, Kanis JA, Olafsson G, Singer AJ, Åkesson K. Health economic aspects of vertebral augmentation procedures. Osteoporos Int 2015; 26:1239-49. [PMID: 25381046 DOI: 10.1007/s00198-014-2953-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 10/27/2014] [Indexed: 01/17/2023]
Abstract
We reviewed all peer-reviewed papers analysing the cost-effectiveness of vertebroplasty and balloon kyphoplasty for osteoporotic vertebral compression fractures. In general, the procedures appear to be cost effective but are very dependent upon model input details. Better data, rather than new models, are needed to answer outstanding questions. Vertebral augmentation procedures (VAPs), including vertebroplasty (VP) and balloon kyphoplasty (BKP), seek to stabilise fractured vertebral bodies and reduce pain. The aim of this paper is to review current literature on the cost-effectiveness of VAPs as well as to discuss the challenges for economic evaluation in this research area. A systematic literature search was conducted to identify existing published studies on the cost-effectiveness of VAPs in patients with osteoporosis. Only peer-reviewed published articles that fulfilled the criteria of being regarded as full economic evaluations including both morbidity and mortality in the outcome measure in the form of quality-adjusted life years (QALYs) were included. The search identified 949 studies, of which four (0.4 %) were identified as relevant with one study added later. The reviewed studies differed widely in terms of study design, modelling framework and data used, yielding different results and conclusions regarding the cost-effectiveness of VAPs. Three out of five studies indicated in the base case results that VAPs were cost effective compared to non-surgical management (NSM). The five main factors that drove the variations in the cost-effectiveness between the studies were time horizon, quality of life effect of treatment, offset time of the treatment effect, reduced number of bed days associated with VAPs and mortality benefit with treatment. The cost-effectiveness of VAPs is uncertain. In answering the remaining questions, new cost-effectiveness analysis will yield limited benefit. Rather, studies that can reduce the uncertainty in the underlying data, especially regarding the long-term clinical outcomes of VAPs, should be conducted.
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Beall DP, McRoberts WP, Berven SH, Ledlie JT, Tutton SM, Parsons BP. Critique of the analysis of UpToDate.com on the treatment of painful vertebral compression fractures: time to update UpToDate. AJNR Am J Neuroradiol 2015; 36:631-6. [PMID: 25414003 DOI: 10.3174/ajnr.a4095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 06/30/2014] [Indexed: 11/07/2022]
Abstract
The treatment of painful vertebral compression fractures has changed substantially since the introduction of vertebroplasty in the mid-1980s and balloon kyphoplasty in the late 1990s. Both procedures were widely accepted with the vertebral fractures treated reaching 150,000 per annum in 2009 prior to the publication of 2 randomized controlled trials comparing vertebroplasty with a sham treatment published in the New England Journal of Medicine in August 2009. Since then, there has been a flood of information on vertebral augmentation and balloon kyphoplasty. It is worth evaluating this information especially because it relates to current recommendations that are often followed blindly by medical and administrative groups unfamiliar with either the procedure or the high level of evidence surrounding vertebral augmentation. To streamline the evaluation of some current recommendations, we limited the analysis to the recommendations found on UpToDate.com. This Web site is an evidence-based, peer-reviewed source of information available for patients, doctors, health insurance companies, and population-based medical decision-making.
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Affiliation(s)
- D P Beall
- From Radiology Services (D.P.B.), Clinical Radiology of Oklahoma, Musculoskeletal Imaging and Interventional, Oklahoma City, Oklahoma
| | - W P McRoberts
- Interventional Spine and Pain Medicine (W.P.M.), Holy Cross Hospital, Fort Lauderdale, Florida
| | - S H Berven
- Department of Orthopaedic Surgery (S.H.B.), University of California San Francisco, San Francisco, California
| | - J T Ledlie
- Tyler Neurosurgery (J.T.L.), Tyler, Texas
| | - S M Tutton
- Departments of Radiology and Surgery (S.M.T.), Medical College of Wisconsin, Froedtert East Clinic, Milwaukee, Wisconsin
| | - B P Parsons
- Department of Radiology (B.P.P.), University of Oklahoma College of Medicine, Edmond, Oklahoma
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Chen L, Black C, Hirsch JA, Beall D, Munk P, Murphy K. Vertebroplasty trials: the medium is the message. J Vasc Interv Radiol 2014; 25:323-5. [PMID: 24461134 DOI: 10.1016/j.jvir.2013.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/04/2013] [Accepted: 10/04/2013] [Indexed: 11/26/2022] Open
Affiliation(s)
- Long Chen
- Department of Radiology, Toronto Western Hospital, University of Toronto, Fitzgerald Building, 150 College St., Room 112, Toronto, Ontario, Canada M5S 3E2
| | - Carl Black
- Utah Valley Regional Medical Center, Provo, Utah
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Doug Beall
- Radiology Services, Summit Medical Center, Oklahoma City, Oklahoma
| | - Peter Munk
- Department of Radiology, Vancouver General Hospital, Vancouver BC, Canada
| | - Kieran Murphy
- Department of Radiology, Toronto Western Hospital, University of Toronto, Fitzgerald Building, 150 College St., Room 112, Toronto, Ontario, Canada M5S 3E2
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30
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Santiago FR, Chinchilla AS, Álvarez LG, Abela ALP, García MDMC, López MP. Comparative review of vertebroplasty and kyphoplasty. World J Radiol 2014; 6:329-343. [PMID: 24976934 PMCID: PMC4072818 DOI: 10.4329/wjr.v6.i6.329] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/18/2014] [Accepted: 05/08/2014] [Indexed: 02/06/2023] Open
Abstract
The aim of this review is to compare the effectiveness of percutaneous vertebroplasty and kyphoplasty to treat pain and improve functional outcome from vertebral fractures secondary to osteoporosis and tumor conditions. In 2009, two open randomized controlled trials published in the New England Journal of Medicine questioned the value of vertebroplasty in treating vertebral compression fractures. Nevertheless, the practice of physicians treating these conditions has barely changed. The objective of this review is to try to clarify the most important issues, based on our own experience and the reported evidence about both techniques, and to guide towards the most appropriate choice of treatment of vertebral fractures, although many questions still remain unanswered.
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Lehman VT, Wood CP, Hunt CH, Carter RE, Allred JB, Diehn FE, Morris JM, Wald JT, Thielen KR. Facet joint signal change on MRI at levels of acute/subacute lumbar compression fractures. AJNR Am J Neuroradiol 2013; 34:1468-73. [PMID: 23449650 DOI: 10.3174/ajnr.a3449] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE The prevalence of facet joint signal change in acute/subacute lumbar vertebral body compression fractures is unknown. We hypothesized that facet joint signal change on MR imaging is more common in facet joints associated with an acute/subacute lumbar compression fracture than those associated with normal vertebral bodies or ones that have a chronic compression fracture. MATERIALS AND METHODS Three neuroradiologists and a neuroradiology fellow retrospectively graded facet joint inflammatory change on MR imaging in 900 facet joints in 75 patients with at least 1 painful osteoporotic lumbar compression fracture. Facet joint signal change was assessed on T2-weighted images with chemical fat-saturation, STIR images, and/or gadolinium-enhanced T1-weighted images with chemical fat-saturation. Each facet joint from the T12/L1 to L5/S1 level was assessed individually. An overall facet joint signal-change score, which is a composite measure of the grade of signal change for all 4 facet joints associated with a given lumbar vertebral level, was devised, and statistical significance was assessed via Wilcoxon rank sum tests. RESULTS The overall facet joint signal-change scores were significantly higher at vertebral body levels affected by an acute/subacute compression fracture compared with control levels, which were associated with either normal bodies or chronic compression fractures. CONCLUSIONS Our findings suggest an association between facet joint signal change on MR imaging and acute/subacute lumbar vertebral body compression fractures.
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Affiliation(s)
- V T Lehman
- Division of Neuroradiology, Department of Radiology, Mayo Clinic College of Graduate Medical Education, Rochester, MN 55905, USA.
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32
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Svedbom A, Alvares L, Cooper C, Marsh D, Ström O. Balloon kyphoplasty compared to vertebroplasty and nonsurgical management in patients hospitalised with acute osteoporotic vertebral compression fracture: a UK cost-effectiveness analysis. Osteoporos Int 2013; 24:355-67. [PMID: 22890362 PMCID: PMC3691631 DOI: 10.1007/s00198-012-2102-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 07/25/2012] [Indexed: 01/18/2023]
Abstract
UNLABELLED The purpose of the study was to estimate the cost-effectiveness of balloon kyphoplasty compared to nonsurgical management and vertebroplasty for the treatment of hospitalised osteoporotic vertebral compression fractures in the UK. A cost-effectiveness model was constructed and used for analysis. Balloon kyphoplasty may be cost-effective compared to relevant alternatives. INTRODUCTION The objective of this study was to estimate the cost-effectiveness of balloon kyphoplasty (BKP) for the treatment of patients hospitalised with acute osteoporotic vertebral compression fracture (OVCF) compared to percutaneous vertebroplasty (PVP) and nonsurgical management (NSM) in the UK. METHODS A Markov simulation model was developed to evaluate treatment with BKP, NSM and PVP in patients with symptomatic OVCF. Data on health-related quality of life (HRQoL) with acute OVCF were derived from the FREE and VERTOS II randomised clinical trials (RCTs) and normalised to the NSM arm in the FREE trial. Estimated differences in mortality among the treatments and costs for NSM were obtained from the literature whereas procedure costs for BKP and PVP were obtained from three National Health Service hospitals. It was assumed that BKP and PVP reduced hospital length of stay by 6 days compared to NSM. RESULTS The incremental cost-effectiveness ratio was estimated at Great Britain Pound Sterling (GBP) 2,706 per quality-adjusted life year (QALY) and GBP 15,982 per QALY compared to NSM and PVP, respectively. Sensitivity analysis showed that the cost-effectiveness of BKP vs. NSM was robust when mortality and HRQoL benefits with BKP were varied. The cost-effectiveness of BKP compared to PVP was particularly sensitive to changes in the mortality benefit. CONCLUSION BKP may be a cost-effective strategy for the treatment of patients hospitalised with acute OVCF in the UK compared to NSM and PVP. Additional RCT data on the benefits of BKP and PVP compared to simulated sham surgery and further data on the mortality benefits with BKP compared to NSM and PVP would reduce uncertainty.
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Affiliation(s)
- A Svedbom
- OptumInsight, Klarabergsviadukten 90, Hus D, 111 64, Stockholm, Sweden.
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Nieuwenhuijse MJ, van Erkel AR, Dijkstra PDS. Percutaneous vertebroplasty for subacute and chronic painful osteoporotic vertebral compression fractures can safely be undertaken in the first year after the onset of symptoms. ACTA ACUST UNITED AC 2012; 94:815-20. [PMID: 22628598 DOI: 10.1302/0301-620x.94b6.28368] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The optimal timing of percutaneous vertebroplasty as treatment for painful osteoporotic vertebral compression fractures (OVCFs) is still unclear. With the position of vertebroplasty having been challenged by recent placebo-controlled studies, appropriate timing gains importance. We investigated the relationship between the onset of symptoms - the time from fracture - and the efficacy of vertebroplasty in 115 patients with 216 painful subacute or chronic OVCFs (mean time from fracture 6.0 months (sd 2.9)). These patients were followed prospectively in the first post-operative year to assess the level of back pain and by means of health-related quality of life (HRQoL). We also investigated whether greater time from fracture resulted in a higher risk of complications or worse pre-operative condition, increased vertebral deformity or the development of nonunion of the fracture as demonstrated by the presence of an intravertebral cleft. It was found that there was an immediate and sustainable improvement in the level of back pain and HRQoL after vertebroplasty, which was independent of the time from fracture. Greater time from fracture was associated with neither worse pre-operative conditions nor increased vertebral deformity, nor with the presence of an intravertebral cleft. We conclude that vertebroplasty can be safely undertaken at an appropriate moment between two and 12 months following the onset of symptoms of an OVCF.
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Affiliation(s)
- M J Nieuwenhuijse
- Leiden University Medical Centre, Department of Orthopaedic Surgery, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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Montagu A, Speirs A, Baldock J, Corbett J, Gosney M. A review of vertebroplasty for osteoporotic and malignant vertebral compression fractures. Age Ageing 2012; 41:450-5. [PMID: 22417981 DOI: 10.1093/ageing/afs024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Vertebral compression fractures are a common clinical problem and the incidence of them will increase with the ageing population. Traditionally management has been conservative; however, there has been a growing trend towards vertebroplasty as an alternative therapy in patients with persisting severe pain. NICE produced guidance in 2003 recommending the procedure after 4 weeks of conservative management. Recent high-quality studies have been contradictory and there is currently a debate surrounding the role of the procedure with no agreement in the literature. We examine the evidence in both osteoporotic and malignant vertebral compression fractures; we also describe the benefits and side effects, alternative treatment options and the cost of the procedure. Finally, we recommend when vertebroplasty is most appropriately used based on the best available evidence.
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Affiliation(s)
- Alexandra Montagu
- Department of Elderly Care, Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, London Road, Reading RG1 5AN, UK.
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Hargunani R, Le Corroller T, Khashoggi K, Liu DM, Marchinkow LO, Mudri MJ, Murphy KP, Ouellette HA, Munk PL. An overview of vertebroplasty: current status, controversies, and future directions. Can Assoc Radiol J 2012; 63:S11-7. [PMID: 22717274 DOI: 10.1016/j.carj.2012.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 02/16/2012] [Accepted: 04/02/2012] [Indexed: 02/07/2023] Open
Abstract
Vertebroplasty is a cost-effective procedure for the relief of pain in appropriately selected patients when performed by a skilled practitioner. The currently accepted indications and contraindications for vertebroplasty are reviewed. The techniques routinely used by the authors are presented, including a discussion of recognized complications. Recent controversy has highlighted weaknesses in the practice of technology evaluation, and more robust studies will be required to address these issues across the board in the future more scientifically than has been done in the past.
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Affiliation(s)
- Rikin Hargunani
- Department of Radiology, University of British Columbia, British Columbia, Canada
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