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Curr Pain Headache Rep. 2020 Mar 20;24(5):16. doi: 10.1007/s11916-020-00849-9.

Current Concepts in the Management of Vertebral Compression Fractures.

Author information

1
Creighton University School of Medicine-Phoenix Regional Campus, Phoenix, AZ, USA.
2
Department of Anesthesia, Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA. iurits@bidmc.harvard.edu.
3
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
4
University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
5
Pain Management Centers of America, Paducah, KY, USA.
6
Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
7
Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA.
8
Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.
9
Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.

Abstract

PURPOSE OF REVIEW:

This comprehensive review of current concepts in the management of vertebral compression fractures is a manuscript of vertebral augmentation literature of risk factors, clinical presentation, and management. The objective of this review is to compare outcomes between multiple augmentation techniques and ongoing discussions of effectiveness of vertebral augmentation procedures.

RECENT FINDINGS:

Vertebral compression fractures (VCFs) are a prevalent disease affecting approximately 1.5 million US adults annually. VCFs can cause severe physical limitations, including back pain, functional disability, and progressive kyphosis of the thoracic spine that ultimately results in decreased appetite, poor nutrition, impaired pulmonary function, and spinal cord compression with motor and sensory deficits. The deconditioning that affects patients with vertebral compression fractures leads to mortality at a far higher rate than age-matched controls. The management of vertebral compression fractures has been extensively discussed with opponents arguing in favor or restricting conservative management and against augmentation, while proponents argue in favor of augmentation. The literature is well established in reference to the effects on mortality when patients undergo treatment with vertebral augmentation; in over a million patients with vertebral compression fractures treated with vertebral augmentation as compared with patients treated with non-surgical management, the patients receiving augmentation performed well with a decrease in morbidity and mortality. Summary of the literature review shows that understanding the risk factors, appropriate clinical evaluation, and management strategies are crucial. Analysis of the evidence shows, based on level I and II studies, balloon kyphoplasty had significantly better and vertebroplasty tended to have better pain reduction compared with non-surgical management. In addition, balloon kyphoplasty tended to have better height restoration than vertebroplasty.

KEYWORDS:

Kyphoplasty; Osteoporosis; Osteoporotic compression fracture; Vertebral augmentation; Vertebroplasty

PMID:
32198571
DOI:
10.1007/s11916-020-00849-9

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