Ehsanian Reza, To Jimmy, Koshkin Eugene, Petersen Timothy R, Berti Aldo, Rivers W Evan, Sorte Danielle
Division of Physical Medicine and Rehabilitation, Department of Orthopaedics & Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM.
Burrell College of Osteopathic Medicine, Las Cruces, NM.
Pain Physician. 2022 Dec;25(9):E1423-E1431.
Approximately 700,000 individuals experience osteoporotic vertebral compression fractures (OVCF) every year in the United States. Chronic complications from patients and increasing economic burdens continue to be major problems with OVCFs. Multiple treatment options for OVCF are available, including conservative management, surgical intervention, and minimally invasive vertebral augmentation. Prior studies have investigated the utility of vertebral augmentation techniques such as percutaneous vertebroplasty (PVP), balloon vertebroplasty (BVP), and vertebral augmentation with the KivaTM implant on patient mortality with favorable results. The optimal time from OVCF occurrence to vertebral augmentation continues to be a topic of investigation.
To further investigate the effect of the timing of vertebral augmentation on pain outcomes.
A retrospective cohort chart review study.
A single academic center in Albuquerque, New Mexico.
One hundred twenty-six consecutive patient encounters with OVCF diagnosed on imaging and treated with PVP, BVP, or vertebral augmentation with a KivaTM implant between 01/01/2004 and 11/28/2016 were analyzed. The time between fracture and intervention was categorized into < 6 weeks, 6-12 weeks, and >= 12 weeks. Pain scores were measured before and after treatment using the numeric pain rating scale. Statistical analysis using Wilcoxon-Mann-Whitney and Kruskal-Wallis tests were used as appropriate, and effect sizes were described with the Hodges-Lehmann estimates of difference.
The 3 vertebral augmentation procedures compared in this study did not demonstrate statistically significant differences in pain score reduction (P = 0.949). The < 12 weeks group had a median and interquartile range (IQR) pain improvement of 3 (IQR 1,6) versus 1 (IQR 0,4) in the >= 12 weeks group (P = 0.018). Further analysis showed that the median and IQR pain improvement for the < 6 weeks group was 3 (IQR 1,7), for the 6-12 weeks group was 3 (IQR 1,4), and for the >= 12 weeks group was 1 (IQR 0,4). The overall effect of the time category on pain improvement was statistically significant for these groups (P = 0.040). Comparisons between groups only showed differences between the < 6 weeks and >= 12 weeks groups (P = 0.013), with an estimated median difference of 2 (95% CI 0,3). There was no statistically significant relationship between fill percentage and pain relief (P = 0.291).
This is a retrospective cohort study from a single academic center with a limited sample size that lacked a control group and procedural blinding. There was also substantial heterogeneity among patients, fractures, operators, and techniques. Pain relief outcomes are subjective and can be biased by patients as well as physician reporting.
Early intervention (< 12 weeks) with vertebral augmentation in patients with OVCF is associated with improved pain scores when compared to later intervention (> 12 weeks). Very early intervention (< 6 weeks) confers a greater advantage when compared to later intervention (> 12 weeks).
在美国，每年约有70万人发生骨质疏松性椎体压缩骨折（OVCF）。患者的慢性并发症和不断增加的经济负担仍是OVCF的主要问题。OVCF有多种治疗选择，包括保守治疗、手术干预和微创椎体强化术。先前的研究调查了椎体强化技术，如经皮椎体成形术（PVP）、球囊椎体成形术（BVP）以及使用KivaTM植入物进行椎体强化术对患者死亡率的影响，结果良好。从OVCF发生到椎体强化的最佳时间仍是一个研究课题。
进一步研究椎体强化时机对疼痛结局的影响。
一项回顾性队列图表审查研究。
新墨西哥州阿尔伯克基的一个学术中心。
分析了2004年1月1日至2016年11月28日期间连续126例经影像学诊断为OVCF并接受PVP、BVP或使用KivaTM植入物进行椎体强化治疗的患者。骨折与干预之间的时间分为<6周、6 - 12周和≥12周。使用数字疼痛评分量表在治疗前后测量疼痛评分。根据情况使用Wilcoxon - Mann - Whitney检验和Kruskal - Wallis检验进行统计分析，并使用Hodges - Lehmann差异估计描述效应大小。
本研究中比较的3种椎体强化手术在疼痛评分降低方面未显示出统计学上的显著差异（P = 0.949）。<12周组的疼痛改善中位数和四分位间距（IQR）为3（IQR 1,6），而≥12周组为1（IQR 0,4）（P = 0.018）。进一步分析表明，<6周组的疼痛改善中位数和IQR为3（IQR 1,7），6 - 12周组为3（IQR 1,4），≥12周组为1（IQR 0,4）。时间类别对这些组疼痛改善的总体影响具有统计学意义（P = 0.040）。组间比较仅显示<6周组和≥12周组之间存在差异（P = 0.013），估计中位数差异为2（95%CI 0,3）。填充百分比与疼痛缓解之间无统计学上的显著关系（P = 0.291）。
这是一项来自单一学术中心的回顾性队列研究，样本量有限，缺乏对照组且未进行手术盲法。患者、骨折、手术医生和技术之间也存在很大的异质性。疼痛缓解结局是主观的，可能受到患者以及医生报告的影响。
与后期干预（>12周）相比，OVCF患者早期干预（<12周）进行椎体强化与疼痛评分改善相关。与后期干预（>12周）相比，极早期干预（<6周）具有更大优势。
