Marc Nieuwenhuijse, resident, Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, The Netherlands, and others have published a study in the Journal of Joint and Bone Surgery, British Volume, that shows percutaneous vertebroplasty can be performed within two and 12 months after the onset symptoms of an osteoporotic vertebral compression fracture without loss of efficacy or an increased risk of worse pre-operative conditions.
Nieuwenhuijse et al wrote that to date, the impact of later treatment (after onset of symptoms) with percutaneous vertebroplasty on post-operative health-related quality of life (HRQoL), complications, or morbidity has not been assessed. They stated that they investigated the relationship between time from fracture and the effects of vertebroplasty on pain relief and HRQoL. They added: “We also examine whether the later treatment of painful osteoporotic vertebral compression fractures is related to worse pre-operative symptoms (higher pain levels and/or lower HRQoL), increased collapse of the vertebral body, or the development of fracture non-union.”
All of the 115 patients in the retrospective study (with a mean of 216 fractures between them and each patient having a mean of 1.9 fractures) had undergone (unsuccessful) conservative therapy for at least two months prior to being treated with vertebroplasty. The mean time between onset of symptoms and vertebroplasty was six months.
Prior to treatment, the mean pre-operative back pain and severe back pain scores were 8 and 9. Nieuwenhuijse et al reported: “After one, four, 12, and 52 weeks, post-operatively, the mean back pain scores were 5.1, 5.7. 4.6, and 4.3, respectively (p<0.001), and the severe back pain scores were 6, 6.5, 5.3, and 5.1, respectively (p<0.001).” They added after vertebroplasty, patient satisfaction was significantly higher than indifference (p<0.001).
The time between onset of symptoms and treatment was not associated with any change in post-operative patient-reported outcomes, and greater time from fracture was not associated with higher pre-operative pain or lower pre-operative HRQoL. Additionally, the degree of pre-operative collapse or the presence of an intervertebral cleft was not related to the time from fracture. Nieuwenhuijse et al wrote that this was an important finding because “both an increased collapse of the vertebral body and the presence of an intervertebral cleft have been associated with an increased morbidity.”
Concluding, Nieuwenhuijse et al commented that their study showed that percutaneous vertebroplasty could safely be performed between two and 12 months after the onset of symptoms “without loss of efficacy and this is not at the cost of a worse pre-operative condition, progressive collapse, or the development of non-union as shown by the presence of an intervertebral cleft.” They also said that their study “shows it is feasible to delay vertebroplasty until a thorough patient evaluation is complete and possible alternative forms of treatment have been considered.”
Nieuwhenhuijse told Spinal News International: “I think it is important to let the clinician decide when percutaneous vertebroplasty should be performed; it should be the clinician’s decision based on the current health status of the patient, and this may vary from patient to patient.”