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Vertebral Compression Fractures - Kyphoplasty or Conservative Care in the Older Patient
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Posted on: 11/30/1999
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Fragility fractures have been shown to be associated with increase in mortality. One of the more common fragility fractures is of the hip. Early operative surgical interventions for patients with hip fractures have been shown to reduce mortality. Because kyphoplasty after vertebral compression fracture has a positive improvement in pain, mobility and function should be allowed earlier than with non-operative care. Therefore, it seems likely that mortality with kyphoplasty would be reduced compared to treatment with conservative care.
Since the incidence of vertebral compression fracture is 700,000 per year, the authors of this study were interested in the effect of kyphoplasty on mortality. Studies have shown mortality rates after vertebral compression fracture are between 23 percent, and 67.5 percent.
The authors of the study retrospectively reviewed the charts of subjects with vertebral compression fractures between June 2000, and June 2004. The subjects were divided into two groups, those who underwent kyphoplasty, and those who chose conservative care to include oral analgesics and back brace All subjects were from the practice of one orthopedic surgeon. The study ended September, 2006. The end point that was evaluated was patient death within the study time period.
There were 94 subjects who chose kyphoplasty to treat vertebral compression fracture. There were 90 patients in the group that chose conservative care
Thirty-eight of the patients who underwent kyphoplasty died. Twenty-six of the patients who chose conservative care died. Age was a significant difference, with those undergoing kyphoplasty having an average age of 76.9 years, and those choosing conservative care, 68.6 years.
The authors concluded that kyphoplasty did not seem to effect the survival of patients after vertebral compression fracture. However, there was a significant difference in age between those treated with kyphoplasty, and those that chose conservative care in this study population that could have affected outcomes. The length of the study was also relatively short. Other co-morbidities were not significantly different, nor were gender between the two groups.
The authors suggest that while their study does not show that kyphoplasty reduces mortality from vertebral compression fracture, it does allow for a more comfortable return to activities of daily living.
1. Is there a significant risk of mortality following vertebral compression fracture?
Yes, a recent study evaluated available literature. The authors found that the mortality rate ranged between 23 and 67 percent.
2. What treatment options are available for vertebral compression fracture?
The usual two options are conservative care and kyphoplasty. An orthopedic surgeon who recently authored an article, compared the mortality between these two treatment options. Kyphoplasty is the placement of bone cement into the vertebral body using a needle that is guided by x-ray. Conservative care usually involves the use of oral analgesics, activity restriction, and bracing.
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References:
W.F. Lavele et al. Effect of kyphoplasty on survival after vertebral compression fractures. SpineJ. September 2008. Volume 8. Issue 5. Pp. 763-769
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