BACKGROUND AND PURPOSE: We analyzed the natural course of conservatively treated osteoporotic vertebral compression fractures from VERTOS II, a randomized trial of vertebroplasty and conservative therapy in 202 patients with vertebral compression fractures. We assessed the proportion of patients who developed chronic back pain and possible risk factors. MATERIALS AND METHODS: In VERTOS II, the VAS score was assessed at regular intervals until 1 year follow-up. We followed 95 conservatively treated patients until sufficient pain relief, defined as a VAS score ≤3. These patients were censured at the involved follow-up interval. In addition, baseline clinical and imaging data, and class of pain medication used in patients with a VAS score ≤3 at any follow-up interval were compared with those in patients with a VAS score >3 at every follow-up by using logistic regression analysis. RESULTS: During 1 year of follow-up, 57 of 95 patients (60%) had sufficient pain relief with VAS scores ≤3. Thirty-eight patients (40%) still had pain with VAS-scores ≥4 at the last follow-up interval of 12 months, despite the use of higher class pain medication. Statistical analysis showed no risk factors. CONCLUSIONS: In the VERTOS II trial, most conservatively treated patients with acute osteoporotic compression fractures had sufficient pain relief during the first 3 months. However, after 1 year, a substantial proportion of patients still had disabling pain despite higher class pain medication used. There were no predictors for the development of chronic pain. Patients with continuing pain ≥3 months after the fracture may be candidates for vertebroplasty.
RCT Entities:
BACKGROUND AND PURPOSE: We analyzed the natural course of conservatively treated osteoporotic vertebral compression fractures from VERTOS II, a randomized trial of vertebroplasty and conservative therapy in 202 patients with vertebral compression fractures. We assessed the proportion of patients who developed chronic back pain and possible risk factors. MATERIALS AND METHODS: In VERTOS II, the VAS score was assessed at regular intervals until 1 year follow-up. We followed 95 conservatively treated patients until sufficient pain relief, defined as a VAS score ≤3. These patients were censured at the involved follow-up interval. In addition, baseline clinical and imaging data, and class of pain medication used in patients with a VAS score ≤3 at any follow-up interval were compared with those in patients with a VAS score >3 at every follow-up by using logistic regression analysis. RESULTS: During 1 year of follow-up, 57 of 95 patients (60%) had sufficient pain relief with VAS scores ≤3. Thirty-eight patients (40%) still had pain with VAS-scores ≥4 at the last follow-up interval of 12 months, despite the use of higher class pain medication. Statistical analysis showed no risk factors. CONCLUSIONS: In the VERTOS II trial, most conservatively treated patients with acute osteoporotic compression fractures had sufficient pain relief during the first 3 months. However, after 1 year, a substantial proportion of patients still had disabling pain despite higher class pain medication used. There were no predictors for the development of chronic pain. Patients with continuing pain ≥3 months after the fracture may be candidates for vertebroplasty.
Authors: Caroline A H Klazen; Paul N M Lohle; Jolanda de Vries; Frits H Jansen; Alexander V Tielbeek; Marion C Blonk; Alexander Venmans; Willem Jan J van Rooij; Marinus C Schoemaker; Job R Juttmann; Tjoen H Lo; Harald J J Verhaar; Yolanda van der Graaf; Kaspar J van Everdingen; Alex F Muller; Otto E H Elgersma; Dirk R Halkema; Hendrik Fransen; Xavier Janssens; Erik Buskens; Willem P Th M Mali Journal: Lancet Date: 2010-08-09 Impact factor: 79.321
Authors: M H J Voormolen; W P T M Mali; P N M Lohle; H Fransen; L E H Lampmann; Y van der Graaf; J R Juttmann; X Jansssens; H J J Verhaar Journal: AJNR Am J Neuroradiol Date: 2007-03 Impact factor: 3.825
Authors: Caroline A H Klazen; Harald J J Verhaar; Paul N M Lohle; Leo E H Lampmann; J R Juttmann; M C Schoemaker; K J van Everdingen; A F Muller; W P Th M Mali; J de Vries Journal: J Vasc Interv Radiol Date: 2010-09 Impact factor: 3.464
Authors: Gregg H Zoarski; Paige Snow; Wayne J Olan; M J Bernadette Stallmeyer; Bradley W Dick; J Richard Hebel; Marian De Deyne Journal: J Vasc Interv Radiol Date: 2002-02 Impact factor: 3.464
Authors: Rachelle Buchbinder; Richard H Osborne; Peter R Ebeling; John D Wark; Peter Mitchell; Chris Wriedt; Stephen Graves; Margaret P Staples; Bridie Murphy Journal: N Engl J Med Date: 2009-08-06 Impact factor: 91.245
Authors: J Kevin McGraw; John A Lippert; Kirk D Minkus; Parag M Rami; Thomas M Davis; Ronald F Budzik Journal: J Vasc Interv Radiol Date: 2002-09 Impact factor: 3.464
Authors: Joseph L Laratta; Jamal N Shillingford; Joseph M Lombardi; John D Mueller; Hemant Reddy; Comron Saifi; Charla R Fischer; Steven C Ludwig; Lawrence G Lenke; Ronald A Lehman Journal: J Spine Surg Date: 2017-09