494 - Osteoporotic Thoracolumbar Vertebral Fractures. Long Term Comparison b...

#494 Osteoporotic Thoracolumbar Vertebral Fractures. Long Term Comparison between Conservative Treatment and Percutaneous Vertebroplasty

Oral Posters: Quality of Spine Care

Presented by: K. Martikos

Author(s):

K. Martikos (1)
F. Lolli (1)
F. Vommaro (1)
M. Di Silvestre (1)
T. Greggi (1)

(1) Rizzoli Orthopaedic Institute, Spine Surgery Department, Bologna, Italy

Abstract

Introduction: Retrospective comparison of long term results in the treatment of vertebral osteoporotic fractures treated with conservative treatment (CT) and percutaneous vertebroplasty (PV).

Materials and Methods: Retrospective evaluation of 85 consecutive patients (72 female and 23 male), treated between 2004 and 2007. The inclusion criteria were acute thoracolumbar fractures (considering levels from T12 to L2) and presence of osteoporosis documented with traditional densitometry. Minimum patients' age was 51 years while mean age was 71 years. 47 patients received CT with bad rest and brace, and 38 patients were treated with PV. Mean follow up was 2.8 years (min 2 years, max 4 years). Clinical and radiographic evaluation was performed at final follow-up by using respectively VAS, ODI and SF-36 questionnaires and segmental sagittal plane kyphosis indexes: sagittal plane kyphosis 1 (SPK1), sagittal plane kyphosis 2 (SPK2), body angle (BA) and sagittal index (SI). Statistical differences were evaluated by using the Student T-score.

Results: In terms of clinical results, no statistically significant differences were registered between the 2 different treatments at final follow up. 8 patients, initially treated conservatively, were later treated with PV because of persistent pain, after a mean 3 months period (min. 2 months, max 4 months). Final radiographic evaluation revealed a better SPK2 in CV (-2.27 vs +2.8, P>0,005), while there were no statistically significant differences in terms of SPK1. PV reached better results in terms of vertebral body height restoration (BA -1.50 vs 2.49 and SI -0.22 vs 0.04, P< 0.05 for both indexes) but no statistical correlation was found between segmental sagittal plane indexes and life quality in the 2 groups.

Conclusions: No statistically significant differences in long term clinical outcome between CT and PV. Vertebroplasty provides better vertebral body height restoration, but this element does not correlate statistically to life quality outcome. Cement leakage, other intraoperatory complications, and future adjacent vertebral fractures (11.1%) represent potential complications.