Symptomatic relief of pain following percutaneous vertebroplasty compared to conservative management in patients with osteoporotic vertebral compression fractures: A prospective cohort study from a low-middle-income country

Abstract

Objectives: To determine the efficacy of percutaneous vertebroplasty in pain management over conservative management in patients with osteoporotic vertebral compression fractures.

Materials and Methods: A prospective cohort study was conducted from 13^th December 2018 to 12^th December 2019 at PIMS/SZABMU, Islamabad, Pakistan. A total of 76 patients (Aged: 35-75 years) of both genders having osteoporotic vertebral compression fractures involving a maximum of two vertebrae were enrolled. Patients were divided equally into two groups. One group was managed surgically through vertebroplasty (Group A) and the other group was managed conservatively (Group B). All the patients were asked about the intensity of pain, assessed by Visual Analogue Scale (VAS) score at the presentation and after 24 hours, 3^rd and 6^th week of given treatment and compared using independent sample t-test in both groups. Complications were also assessed and compared in both groups.

Results: In group A, dorsal vertebrae were involved in 23.7%, lumbar vertebrae in 68.4% and dorsal/lumbar vertebrae in 7.9% of cases. In group B, dorsal vertebrae were involved in 21.1%, lumbar vertebrae in 60.5% and dorsal/lumbar vertebrae in 18.4% of cases. At baseline, mean VAS was 8.01 ± 0.99 in group A and it was 8.35 ± 0.75 in group B. At 24 hours after the intervention, mean VAS was 4.37 ± 0.79 in group A and it was 7.29 ± 1.21 in group B. At 3 weeks after the intervention, mean VAS was 4.03 ± 0.85 in group A and it was 6.37 ± 0.91 in group B and at 6 weeks after the intervention, mean VAS was 3.87 ± 1.09 in group A and it was 5.37 ± 0.97 in group B. The overall complication rate was 10.5% at 24 hours in group A and it was 5.3% in group B. At 3 weeks, the complication rate was 5.3% in group A and it was 28.9% in group B. At 6 weeks, the complication rate was 21.1% in group A and it was 55.3% in group B patients.

Conclusion: Mean VAS score was found to be significantly lower in patients who underwent vertebroplasty as compared to those managed conservatively. Overall complication rate was similar in both groups at 24 hours, however, it was significantly lower at 3^rd and 6^th weeks in patients who underwent vertebroplasty as compared to those managed conservatively.