Percutaneous vertebroplasty and conservative therapy for osteoporotic vertebral compression fractures: a clinical comparative study

Objective: To evaluate the clinical efficacies of percutaneous vertebroplasty and conservative therapy in patients with osteoporotic vertebral compression fractures. Methods: One hundred and four vertebrae in 83 patients with osteoporotic compression fractures were shown by MRI, CT and plain radiography. Forty four patients with 58 vertebrae were assigned to group 1 treated by PVP, and 39 patients with 46 vertebrae were assigned to group 2 treated by conservative therapy. The efficacies of two groups were evaluated by measuring the heights of vertebrae on the lateral plain films during follow-up. Results: No serious complications occurred with PVP. Pain relief was obtained in all of 44 patients and VAS score decreased from 8.5 before the procedure to 2.6 at 1 week after PVP(improvement of 5.9). Pain still remained in all 39 patients at 1 week after conservative treatment. Improvement was significantly greater in the group 1 than in group 2 at 1 week, 1 month and 3 months, but no difference at 6 months after treatment (P>0.05). Within 8.9 months of mean follow-up, 3 new fractures occurred in 3 patients in group 1, 2 new fractures occurred in 2 patients in group 2, showing no significant difference. The average increase in vertebral body height on the X-ray plains at 1 week after PVP was 2.2 mm anteriorly, 2.3 mm centrally and unchanged posteriorly. Comparing with the plain film at 1 week after PVP, the heights of vertebrae showed no significant difference at 3 and 6 months of follow-up respectively the heights of vertebrae were unchanged at 1 week after conservative therapy. Average reduction in vertebral body height was 1.9 mm anteriorly, 2.1 mm centrally, unchanged posteriorly at 3 months, but no more collapse at 6 months after conventional treatment. The vertebral body height was significantly higher in the group 1 than in group 2 at 3 months after treatment. Conclusions: PVP is an effective and safe procedure for treating persistent painful osteoporotic vertebral compression fractures and shortening the course of disease. Pain relief showed no difference at 5 months follow up with conventional treatment; a outcoming with increase of vertebral body height and preventing further collapse of the vertebra. New fractures following vertebroplasty may actually represent presence of osteoporosis rather than a complication of the procedure. (authors)