Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, USA.
Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, USA.
World Neurosurg. 2020 Sep;141:e453-e460. doi: 10.1016/j.wneu.2020.05.199. Epub 2020 May 28.
Many treatment options for osteoporotic vertebral fractures are available. However, limited and variable findings have been reported on the efficacy of the individual therapies. The objective of the present study was to systematically review the reported data for evidence of efficacy of spinal orthoses for osteoporotic vertebral fractures.
A systematic review of the PubMed database was performed. Two reviewers evaluated the studies found for eligibility. Randomized controlled trails (RCTs) and prospective nonrandomized, prospective single-arm, and retrospective comparative studies of the treatment of acute osteoporotic vertebral fractures with spinal orthoses were included.
A total of 16 studies were included: 5 RCTs, 6 nonrandomized prospective comparative studies, 1 retrospective case-control study, and 4 prospective single-arm studies. Of the 16 studies, 4 (3 single-arm studies and 1 nonrandomized study) provided low-quality evidence that bracing, with or without bedrest, was safe. Also, 1 nonrandomized and 1 single-arm study provided low-quality evidence that bracing improved pain and disability. In addition, 4 studies demonstrated that the use of a rigid brace was equivalent to the use of a soft brace or no brace (2 high-quality RCTs, 2 nonrandomized studies, 1 low-quality RCT). Two nonrandomized and one case-control study demonstrated a benefit of kyphoplasty compared with bracing alone (all low quality). Two RCTs had provided low-quality evidence that bracing was superior to no brace and one nonrandomized study provided low-quality evidence that a dynamic brace was superior to rigid orthosis.
Limited evidence has suggested the safety of spinal orthoses for the treatment of osteoporotic compression fractures. At present, compelling evidence is not available to suggest that a rigid brace is superior to a soft brace or no brace. Kyphoplasty might be of benefit for select patients.
骨质疏松性椎体骨折有多种治疗选择。然而，对于各种疗法的疗效，已有报道的结果有限且不一致。本研究旨在系统地综述报道的关于脊柱支具治疗骨质疏松性椎体骨折疗效的证据。
对 PubMed 数据库进行了系统的回顾。两名评审员评估了符合条件的研究。纳入了使用脊柱支具治疗急性骨质疏松性椎体骨折的随机对照试验（RCT）和前瞻性非随机、前瞻性单臂和回顾性比较研究。
共纳入 16 项研究：5 项 RCT、6 项非随机前瞻性比较研究、1 项回顾性病例对照研究和 4 项前瞻性单臂研究。16 项研究中，4 项（3 项单臂研究和 1 项非随机研究）提供了低质量证据，表明支具固定（伴或不伴卧床休息）是安全的。此外，1 项非随机和 1 项单臂研究提供了低质量证据，表明支具固定可改善疼痛和残疾。此外，4 项研究表明，使用刚性支具与使用软性支具或不使用支具等效（2 项高质量 RCT、2 项非随机研究、1 项低质量 RCT）。2 项非随机和 1 项病例对照研究表明，球囊扩张成形术与支具固定单独治疗相比具有优势（均为低质量）。2 项 RCT 提供了低质量证据表明支具固定优于不使用支具，1 项非随机研究提供了低质量证据表明动态支具优于刚性支具。
有限的证据表明脊柱支具治疗骨质疏松性压缩性骨折是安全的。目前，没有令人信服的证据表明刚性支具优于软性支具或不使用支具。球囊扩张成形术可能对某些患者有益。
