Interventional Radiology, Villa Maria Hospital, Turin, Italy; St Georges Hospital, London, United Kingdom; Department for Spine Surgery and Traumatology, Orthopaedische Fachklinik Schwarzach, Schwarzach/Munich, Germany; Bicetre University Hospital, AP-HP.
Pain Physician. 2013 Sep-Oct;16(5):E519-30.
The heterogeneity of patients with osteoporotic vertebral compression fractures (VCF) necessitates a tailored approach of balancing the benefits and limitations of available treatments. Current guidelines are divergent, sometimes contradictory, and often insufficiently detailed to guide practice decisions.
This study aimed at establishing treatment recommendations at the patient-specific level.
Using the RAND/UCLA Appropriateness Method (RAM), the appropriateness of different treatment options for osteoporotic VCFs was assessed.
The assessment was conducted by a European multidisciplinary panel of 12 experts.
The appropriateness of non-surgical management (NSM), vertebroplasty (VP), and balloon kyphoplasty (BKP) was determined for 128 hypothetical patient profiles. These were unique combinations of clinical factors considered relevant to treatment choice (time since fracture, MRI findings, impact and evolution of symptoms, spinal deformity, ongoing fracture process, and pulmonary dysfunction). After 2 individual rating rounds and plenary meetings, appropriateness statements (appropriate, inappropriate, and uncertain) were calculated for all clinical scenarios.
Disagreement dropped from 31% in the first round to 7% in the second round. Appropriateness outcomes showed specific patterns for the 3 treatments. For three-quarters of the profiles, only one treatment was considered appropriate: NSM 25%, VP 6%, and BKP 45%. NSM was usually appropriate in patients with a negative MRI or a positive MRI without other unfavorable conditions (poor outcomes for the other variables). VP was usually appropriate in patients with a positive MRI, time since fracture ≥ 6 weeks, and no spinal deformity. BKP was recommended for all patients with an ongoing fracture process, and also in most patients with a positive MRI and ≥ 1 other unfavorable factor.
The prevalence of the patient profiles in daily practice is yet unknown.
The panel results may help to support treatment choice in the heterogeneous population of patients with osteoporotic VCF.
患有骨质疏松性椎体压缩性骨折（VCF）的患者存在异质性，需要采取量身定制的方法来平衡现有治疗方法的利弊。目前的指南存在分歧，有时甚至相互矛盾，并且通常不够详细，无法指导实践决策。
本研究旨在确定针对特定患者的治疗建议。
使用 RAND/UCLA 适宜性方法（RAM）评估骨质疏松性 VCF 不同治疗选择的适宜性。
该评估由来自欧洲的 12 名多学科专家组成的小组进行。
通过独特的组合临床因素（骨折后时间、MRI 结果、症状的影响和演变、脊柱畸形、持续骨折过程和肺功能障碍），确定了 128 个假设患者的非手术治疗（NSM）、椎体成形术（VP）和球囊扩张椎体后凸成形术（BKP）的适宜性。在进行了 2 次单独的评分轮次和全体会议后，为所有临床情况计算了适宜性陈述（适宜、不适宜和不确定）。
第一轮中的意见分歧从 31%降至第二轮的 7%。适宜性结果显示出 3 种治疗方法的特定模式。对于四分之三的患者，只有一种治疗方法被认为是合适的：NSM 25%、VP 6%和 BKP 45%。对于 MRI 结果为阴性或 MRI 结果阳性但没有其他不利条件的患者（其他变量的预后较差），通常建议采用 NSM。对于 MRI 结果阳性、骨折后时间≥6 周且没有脊柱畸形的患者，VP 通常是合适的。对于持续骨折过程的所有患者，以及大多数 MRI 结果阳性且≥1 个其他不利因素的患者，建议采用 BKP。
患者在日常实践中的患病率尚不清楚。
小组的结果可能有助于支持骨质疏松性 VCF 患者异质性人群的治疗选择。
