Pourtaheri Sina, Luo William, Cui Christina, Garfin Steven
Department of Orthopaedic Surgery, University of California.
School of Medicine, University of California, La Jolla, San Diego, CA.
Clin Spine Surg. 2018 Oct;31(8):339-344. doi: 10.1097/BSD.0000000000000670.
This is a systematic review and meta-analysis.
This study's goal was to (i) assess the clinical outcomes with and without vertebral augmentation (VA) for osteoporotic vertebral compression fractures (VCFs) with versus without correlating signs and symptoms; and (ii) acute (symptoms <3 mo duration) and subacute VCFs (3-6 mo duration) versus chronic VCFs (>6 mo).
Previously, a randomized controlled trial in the New England Journal of Medicine concluded that vertebroplasty for osteoporotic VCFs provided no clinical benefit over sham surgery. However, the VCFs examined had no clinical correlation with symptom, physical examination, or imaging (magnetic resonance imaging/bone scan) findings. Nonetheless, the randomized controlled trial resulted in a reduction in VA performed in the United States. Currently, no consensus exists on VA versus nonoperative care for symptomatic VCFs (SVFs).
A literature search was conducted for studies on VA and conservative management for VCFs. Meta-analysis was performed using the random-effects model. The primary outcome was improvement in lower back pain visual analog score. SVFs were defined as radiographic VCF with clinical correlation. Radiographic-alone VCF (RVF) was defined as radiographic VCF without clinical correlation.
Thirteen studies totaling 1467 patients with minimum 6-month follow-up were found. Pain reduction was greater with VA over conservative management for SVFs (P<0.000001) and equivalent for RVFs (P=0.22). Subanalysis for acute/subacute SVFs and chronic SVFs showed that VA was superior to nonoperative care (P=0.0009 and 0.04, respectively). No difference was observed in outcomes between VA and nonoperative care for chronic RVF (P=0.22).
VA is superior to nonoperative care in reducing lower back pain for osteoporotic VCFs with correlating signs and symptoms. VA had no benefit over nonoperative care for chronic VCFs that lacked clinical correlation. Lower back pain has many etiologies and patients should be clinically assessed before recommending VA.
这是一项系统评价和荟萃分析。
本研究的目标是：（i）评估有或无相关体征和症状的骨质疏松性椎体压缩骨折（VCF）接受或未接受椎体强化（VA）治疗的临床结局；以及（ii）急性（症状持续时间<3个月）和亚急性VCF（3 - 6个月）与慢性VCF（>6个月）的情况。
此前，《新英格兰医学杂志》上的一项随机对照试验得出结论，骨质疏松性VCF的椎体成形术与假手术相比并无临床益处。然而，所检查的VCF与症状、体格检查或影像学（磁共振成像/骨扫描）结果并无临床相关性。尽管如此，该随机对照试验导致美国进行的VA手术减少。目前，对于有症状的VCF（SVF），在VA与非手术治疗方面尚未达成共识。
对关于VCF的VA和保守治疗的研究进行文献检索。使用随机效应模型进行荟萃分析。主要结局是下腰痛视觉模拟评分的改善。SVF被定义为具有临床相关性的影像学VCF。单纯影像学VCF（RVF）被定义为无临床相关性的影像学VCF。
共找到13项研究，总计1467例患者，随访时间至少6个月。对于SVF，VA治疗比保守治疗的疼痛减轻更明显（P<0.000001），对于RVF则相当（P = 0.22）。对急性/亚急性SVF和慢性SVF的亚组分析表明，VA优于非手术治疗（分别为P = 0.0009和0.04）。对于慢性RVF，VA与非手术治疗的结局无差异（P = 0.22）。
对于有相关体征和症状的骨质疏松性VCF，VA在减轻下腰痛方面优于非手术治疗。对于缺乏临床相关性的慢性VCF，VA与非手术治疗相比并无益处。下腰痛有多种病因，在推荐VA之前应对患者进行临床评估。
