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Prospective Measurement of Function and Pain in Patients with Non-Neoplastic Compression Fractures Treated with Vertebroplasty
Heidi Prather, DO1; Linda Van Dillen, PT, PhD2; John P. Metzler, MD1; K. Daniel Riew, MD1; Louis A. Gilula, MD3
1 Department of Orthopaedic Surgery, Washington University School of Medicine, 1 Barnes-Jewish Hospital Plaza Drive, Suite 11300 West Pavilion, St. Louis, MO 63110
2 Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Boulevard, Box 8502, St. Louis, MO 63108
3 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110
The Journal of Bone & Joint Surgery.  2006; 88:334-341  doi:10.2106/JBJS.D.02670
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Abstract

Background: There has been an increasing number of reports regarding the benefits of vertebroplasty for the treatment of vertebral compression fractures. In this investigation, validated outcome tools were utilized to document the impact of vertebroplasty on pain and function.

Methods: Fifty patients were recruited at a tertiary university hospital. Patients had been treated for intractable pain due to osteoporotic compression fracture(s) for at least four weeks. The vertebroplasty procedures were performed by a radiologist. The subjects were followed prospectively for one year and received conservative treatment in conjunction with the vertebroplasty. Validated outcome tools, including a visual analog scale, the Oswestry scale, and the Roland-Morris functional activity questionnaire, were used to evaluate changes in pain and functional capabilities.

Results: Fifty patients, thirty-one women and nineteen men (mean age, 68.6 years), were followed prospectively for one year. One hundred and three fractures (fifty-nine thoracic and forty-four lumbar) were treated. The visual analog scale showed the greatest improvement between the baseline score (mean, 7.76) and the score at one month (mean, 2.9), and the score remained improved at one year (mean, 2.9). The Oswestry and Roland-Morris questionnaires demonstrated significant (p < 0.0001) functional improvement between the baseline and one-month scores. With the numbers available, there were no significant changes in any variable from one month to one year (p > 0.05).

Conclusions: Vertebroplasty is an effective treatment for patients with intractable pain due to osteoporotic vertebral compression fractures. Improvement in pain scores and functional capabilities that were found at one month were maintained at one year.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Professor Dr. Klemens Trieb
    Posted on March 09, 2006
    Prospective comparison of vertebroplasty and kyphoplasty
    Dept. of Orthopedics, Klinikum Franfurt/Oder, Hospital of the Humboldt University, Berlin, GERMANY

    To The Editor:

    With interest I read the article on compression fractures treated with vertebroplasty by Prather, et al.(1) In the discussion section (last paragraph) they state that no study has been published that compares the benefits of vertebroplasty with those of kyphoplasty in humans with non-neoplastic fractures.

    I do not agree. I would direct the authors and readers of JBJS to a prospective nonrandomized comparison of vertebroplasty and baloon kyphoplasty that was published last year.(2) It showed that kyphoplasty is superior in non-recent fractures with respect to reduction of kyphotic wedge and decreasing pain over a period of two years, although a higher amount of compression fractures in adjacent levels was observed.

    References:

    1. H. Prather, L. Van Dillen, J.P. Metzler, K. D. Riew, and L. A. Gilula Prospective Measurement of Function and Pain in Patients with Non- Neoplastic Compression Fractures Treated with Vertebroplasty J Bone Joint Surg Am 2006; 88: 334-341

    2. J. G. Grohs, M. Matzner, K. Trieb, P. Krepler. Minimal Invasive Stabilization Of Osteoporotic Vertebral Fractures: A Prospective Nonrandomized Comparison Of Vertebroplasty And Balloon Kyphoplasty. J Spinal Disord Tech. 2005 Jun;18(3):238-42

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