Hatgis Jesse, Palea Ovidiu, Ghomri Yashar, Granville Michelle, Berti Aldo, Jacobson Robert E
Pain Management, Phoenix Neurological and Pain Institute, Chandler, USA.
Anesthesiology and Pain Management, Centrul De Diagnostic Si Tratament Provita, Bucharest, ROU.
Cureus. 2018 Aug 27;10(8):e3208. doi: 10.7759/cureus.3208.
The literature has classified chronic vertebral compression fractures (VCF) as those still "symptomatic" four or more months after onset. Pain is regarded as the predominant chronic symptom; however, radiologic changes are important in evaluating fracture progression. This review examines a series of patients with chronic fractures and both persistence of spinal pain combined with radiologic changes, such as worsening collapse, spinal angulation, the development of vertebral edema and clefts, as well as the development of new fractures at adjacent spinal levels. In patients with clear progressive radiologic changes in addition to pain, vertebral augmentation on an average of 9.3 months after injury was effective in reducing the pain and stabilizing these more chronic osteoporotic fractures. A comparison of the pre- and post-procedure visual analog scale score (VAS) indicated an average of 66% reduction in pain. There are several reasons for the development of chronic symptomatic fractures. Most commonly, interventional treatment is delayed in a patient already diagnosed with VCF after a long period of conservative treatment, yet pain persists, or the initial clinical and radiologic evaluation misses the fracture, leading to a delay in diagnosis and treatment. In this report, management in these patients and the role of late vertebral augmentation for chronic symptomatic fractures is clarified based on the findings of various radiologic changes seen on both initial and follow-up radiologic studies.
文献将慢性椎体压缩性骨折（VCF）定义为发病四个月或更长时间后仍“有症状”的骨折。疼痛被视为主要的慢性症状；然而，放射学改变对于评估骨折进展很重要。本综述研究了一系列慢性骨折患者，这些患者存在脊柱疼痛持续且伴有放射学改变，如椎体塌陷加重、脊柱成角、椎体水肿和裂隙形成，以及相邻椎体水平出现新骨折。对于除疼痛外有明显放射学进展性改变的患者，受伤后平均9.3个月进行椎体强化治疗可有效减轻疼痛并稳定这些更慢性的骨质疏松性骨折。手术前后视觉模拟评分（VAS）比较显示疼痛平均减轻66%。慢性症状性骨折的发生有多种原因。最常见的是，在已经接受长时间保守治疗的VCF患者中，介入治疗延迟，疼痛持续存在，或者最初的临床和放射学评估遗漏了骨折，导致诊断和治疗延迟。在本报告中，根据初始和随访放射学研究中发现的各种放射学改变，阐明了这些患者的治疗方法以及晚期椎体强化治疗对慢性症状性骨折的作用。
