Department of Neurosurgery, Puerta de Hierro University Hospital, IDIPHISA Manuel de Falla 1, Majadahonda-Madrid, 28222, Spain.
Department of Surgery, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029, Madrid, Spain.
BMC Musculoskelet Disord. 2023 Nov 18;24(1):898. doi: 10.1186/s12891-023-07041-1.
Osteoporotic vertebral compression fracture (VCF) is the third most frequent fragility fracture in the world. Conservative treatment, vertebroplasty, and kyphoplasty are all recognized therapies. However, diagnostic and therapeutic recommendations must be more consistent when comparing clinical guidelines. This study aims to compare the efficacy of vertebral augmentation therapy and conservative management for treating VCFs, the risk of subsequent complications, and the length of hospital stay.
All patients over 50 years old with a diagnosis of thoracic or lumbar VCF without underlying oncological process, treated conservatively or surgically, and consecutively attended at our department from January 2017 to June 2021 were retrospectively selected for analysis. Patients who missed follow-up or died during the first three months were excluded.
A total of 573 cases were selected for analysis. Most patients were treated conservatively (85.3%). Both groups were homogenous regarding epidemiological and clinical features. The median time elapsed to achieve pain relief was significantly lower in the surgical cohort (4.5 vs. 10 weeks, p < 0.001), and the proportion of patients reporting pain at the first outpatient visit was also significantly lower with a vertebral augmentation procedure (p = 0.004). The new fracture rate and the adjacent level rate did not differ significantly when comparing both treatments, whereas the progression of the diagnosed fracture was more frequent in the conservative group (4.8% vs. 29.7%; p < 0.001). The median hospital stay was significantly lower in the conservative group (3 vs. 10 days; p < 0.001).
Surgical treatment (vertebroplasty/kyphoplasty) of VCFs was associated with sooner pain relief without an increased risk of new or adjacent fractures. Moreover, the progression of treated fractures was significantly lower in the surgical cohort. The only unfavorable aspect was the more extended hospital stay compared with the conservative treatment group.
骨质疏松性椎体压缩性骨折（VCF）是世界上第三常见的脆性骨折。保守治疗、椎体成形术和后凸成形术都是公认的治疗方法。然而，在比较临床指南时，必须使诊断和治疗建议更加一致。本研究旨在比较椎体增强治疗和保守治疗治疗 VCF 的疗效、后续并发症的风险和住院时间。
回顾性分析 2017 年 1 月至 2021 年 6 月期间在我科连续就诊的 573 例年龄 50 岁以上、无潜在肿瘤过程、接受保守或手术治疗的胸腰椎 VCF 患者。排除失访或随访 3 个月内死亡的患者。
共有 573 例患者入选分析。大多数患者接受保守治疗（85.3%）。两组在人口统计学和临床特征方面均具有同质性。手术组达到疼痛缓解的中位时间明显更短（4.5 周 vs. 10 周，p<0.001），初次门诊时报告疼痛的患者比例也明显较低（p=0.004）。两种治疗方法的新发骨折率和相邻节段率无显著差异，而保守组诊断性骨折进展更为频繁（4.8% vs. 29.7%；p<0.001）。保守组的中位住院时间明显更短（3 天 vs. 10 天；p<0.001）。
VCF 的手术治疗（椎体成形术/后凸成形术）可更快缓解疼痛，且不会增加新发或相邻骨折的风险。此外，手术组治疗性骨折的进展明显较低。与保守治疗组相比，唯一不利的方面是住院时间更长。
