Vertebral augmentation versus conservative treatment in osteoporotic spinal compression fractures: A literature review

Abstract

Background: With greater life expectancies the incidence of osteoporosis is increasing across the African continent. Post-menopausal females are especially at risk and an increasingly common presentation to the orthopaedic surgeon are elderly female patients presenting with symptomatic osteoporotic vertebral compression fractures. Traditional management has for decades been a variable period of bed rest followed by progressive mobilization according to pain. Newer minimally invasive spine procedures, under the umbrella term vertebral augmentation, include vertebroplasty and balloon kyphoplasty and are claimed to shorten the period of bed rest allowing earlier mobilization and earlier functional recovery. We aimed to assess the effectiveness and benefit of these procedures by comparing the results of recently published randomized
clinical control trials that compared them to the conservative approach more commonly employed.

Data source: We conducted a Pubmed and Medline search using the words “Postmenopausal women vertebral augmentation”; “Postmenopausal women kyphoplasty”; “Postmenopausal women vertebroplasty” and “Postmenopausal vertebral compression fractures”. We limited the articles chosen to include only large randomized clinical control trials published in the last 5 years. In total only four suitable articles that met the
criteria for this stringent review were chosen.

Results: Comparing percutaneous vertebroplasty versus the conservative approach the studies unanimously report a significant reduction in immediate and early post-operative pain allowing earlier mobilization. This benefit is however inconsistently significant at as early as 6 weeks follow-up and largely insignificant at 1-year follow-up. Comparing percutaneous vertebroplasty versus percutaneous kyphoplasty there is no significant difference in outcome.

Conclusion: While vertebral augmentation procedures have added immediate and short-term benefit to patients with symptomatic osteoporotic vertebral compression fractures they have, in practice, failed to add significant intermediate and no long-term benefit. Medical management aimed at prevention, combined with the conservative approach in patients that incur these fractures, remain fundamentally entrenched as the cornerstones of modern-day treatment.

Key words: Osteoporotic vertebral compression fractures, Vertebral augmentation, Kyphoplasty, Vertebroplasty