BACKGROUND: There is controversy about how to treat vertebral fractures. Conservative care is the default approach. Radiofrequency kyphoplasty uses ultrahigh viscosity cement to restore spinal posture and stabilize the fracture. The aims of this study were to compare radiofrequency kyphoplasty to conservative care and assess the usual algorithm of starting all patients on conservative care for 6 weeks before offering surgery. METHODS:Elderly patients with painful osteoporotic vertebral compression fractures were all treated with 6 weeks of conservative care (analgesics, bracing, and physiotherapy). They were then offered the choice of continuing conservative care or crossing over to radiofrequency kyphoplasty, at 6 and 12 weeks. Clinical success was defined as: (1) VAS pain improvement ≥2, (2) final VAS pain ≤5, (3) no functional worsening on ODI. RESULTS: After the initial 6 weeks of conservative care, only 1 of 65 patients met the criteria for clinical success, and median VAS improvement was 0. After 12 weeks of conservative care, only 5 of 38 patients met the criteria for clinical success, and median VAS improvement was 1. At the 6-week follow-up after radiofrequency kyphoplasty, 31 of 33 surgery patients met the criteria for clinical success, and median VAS improvement was 5. CONCLUSION: For the vast majority of patients with a VAS ≥5, conservative care did not provide meaningful clinical improvement. In contrast, nearly all patients who underwent radiofrequency kyphoplasty had rapid substantial improvement. Surgery was clearly much more effective than conservative care and should be offered to patients much sooner.
RCT Entities:
BACKGROUND: There is controversy about how to treat vertebral fractures. Conservative care is the default approach. Radiofrequency kyphoplasty uses ultrahigh viscosity cement to restore spinal posture and stabilize the fracture. The aims of this study were to compare radiofrequency kyphoplasty to conservative care and assess the usual algorithm of starting all patients on conservative care for 6 weeks before offering surgery. METHODS: Elderly patients with painful osteoporotic vertebral compression fractures were all treated with 6 weeks of conservative care (analgesics, bracing, and physiotherapy). They were then offered the choice of continuing conservative care or crossing over to radiofrequency kyphoplasty, at 6 and 12 weeks. Clinical success was defined as: (1) VAS pain improvement ≥2, (2) final VAS pain ≤5, (3) no functional worsening on ODI. RESULTS: After the initial 6 weeks of conservative care, only 1 of 65 patients met the criteria for clinical success, and median VAS improvement was 0. After 12 weeks of conservative care, only 5 of 38 patients met the criteria for clinical success, and median VAS improvement was 1. At the 6-week follow-up after radiofrequency kyphoplasty, 31 of 33 surgery patients met the criteria for clinical success, and median VAS improvement was 5. CONCLUSION: For the vast majority of patients with a VAS ≥5, conservative care did not provide meaningful clinical improvement. In contrast, nearly all patients who underwent radiofrequency kyphoplasty had rapid substantial improvement. Surgery was clearly much more effective than conservative care and should be offered to patients much sooner.
Authors: Bryan R Luce; Judith M Kramer; Steven N Goodman; Jason T Connor; Sean Tunis; Danielle Whicher; J Sanford Schwartz Journal: Ann Intern Med Date: 2009-06-30 Impact factor: 25.391
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: David F Kallmes; Bryan A Comstock; Patrick J Heagerty; Judith A Turner; David J Wilson; Terry H Diamond; Richard Edwards; Leigh A Gray; Lydia Stout; Sara Owen; William Hollingworth; Basavaraj Ghdoke; Deborah J Annesley-Williams; Stuart H Ralston; Jeffrey G Jarvik Journal: N Engl J Med Date: 2009-08-06 Impact factor: 91.245
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: Douglas Wardlaw; Steven R Cummings; Jan Van Meirhaeghe; Leonard Bastian; John B Tillman; Jonas Ranstam; Richard Eastell; Peter Shabe; Karen Talmadge; Steven Boonen Journal: Lancet Date: 2009-02-24 Impact factor: 79.321