Management of the Elderly With Vertebral Compression Fractures. (October 2015)

• Record Type: Journal Article
• Authors: Goldstein, Christina L.; Chutkan, Norman B.; Choma, Theodore J.; Orr, R. Douglas
• Other Names: Fehlings Michael G. section editor.; Mroz Thomas section editor.; Choma Theodore J. section editor.; Harrop James S. section editor.
• Is Part Of: Neurosurgery. Volume 77:(2015)Supplement 1
• Publication Date: 2015-10
• Subjects: Elderly -- Kyphoplasty -- Nonoperative management -- Osteoporosis -- Vertebral compression fracture -- Vertebroplasty; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000000947
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : Vertebral compression fractures (VCFs) are the most common type of fracture secondary to osteoporosis. These fractures are associated with significant rates of morbidity and mortality and annual direct medical expenditures of more than $1 billion in the United States. Although many patients will respond favorably to nonsurgical care of their VCF, contemporary natural history data suggest that more than 40% of patients may fail to achieve significant pain relief within 12 months of symptom onset. As a result, percutaneous vertebral augmentation is often used to hasten symptom resolution and return of function. However, controversy regarding the role of kyphoplasty and vertebroplasty in the treatment of symptomatic VCFs exists. The purposes of this review are (1) to outline the epidemiology of VCFs as well as the physical morbidity and economic impact of these injuries, (2) to familiarize the reader with the best available evidence surrounding the operative and nonoperative treatment of VCFs, and (3) to examine the literature pertaining to the cost-effectiveness of surgical management of VCFs with the overarching goal of helping physicians make informed decisions regarding symptomatic VCF treatment. ABBREVIATIONS: AE, adverse event CI, confidence interval KP, kyphoplasty HRQOL, health-related quality of life INVEST, Investigational Vertebroplasty Safety and Efficacy Trial MD, mean difference ODI, Oswestry Disability Index QUALEFFO, Quality of Life Questionnaire of the European Foundation for Osteoporosis RCT, randomized, controlled trial RMDQ, Roland-Morris Disability Questionnaire SF-36, Short Form 36 VCF, vertebral compression fracture VP, vertebroplasty