title: Transpedicular vertebroplasty after intravertebral cavity formation versus conservative treatment for osteoporotic burst fractures.
abstract: BACKGROUND
  There has been no study regarding the comparison between vertebroplasty and conservative treatment for osteoporotic burst fracture.
  
  
  OBJECTIVE
  To compare the results of vertebroplasty after intravertebral cavity formation with that of conservative treatment alone.
  
  
  METHODS
  A case-control study.
  
  
  METHODS
  The vertebroplasty group included 40 consecutive patients with primary osteoporotic burst fracture who underwent vertebroplasty using calcium phosphate cement, and the control group was made up of 40 patients given conservative treatment alone who were matched for age, gender, the injury level, and the type of fracture. Two groups of patients who had no neural deficit were prospectively examined. Clinical and radiological outcomes of these two groups were compared blindly. The authors do not report any conflict of interest in this study.
  
  
  METHODS
  Outcome measures included visual analog scale (VAS) of the back pain, analgesic requirements, and mobility; in a lateral radiograph, the deformity index was measured and expressed as the ratio of the vertebral body (VB) height (sum of measurements at anterior, middle, and posterior regions of VB) to the longitudinal diameter of VB. Anteroposterior height comparison was expressed as the percentage of VB height at the anterior region compared with the height at the posterior region. Each recovery rate was calculated as a percentage by the formula: (value at the examination-value before treatment)/value before treatment × 100.
  
  
  RESULTS
  The duration of follow-up was more than 12 months (mean; 22.5 months). The mean VAS at 12 months after injury was 2.17 cm in the conservative group and 0.61 cm in the vertebroplasty group (p=.0002). The mean duration of analgesic medication required was 157.2 days in the conservative group and 21.3 days in the vertebroplasty group (p=.0048). The mean deformity index at 12 months after injury was 1.66 in the vertebroplasty group and 1.38 in the control group, and the mean recovery rate was +7.3% and -18.4%, respectively (p<.0001). Anteroposterior height comparison at 12 months after injury was 49.1% in the conservative group and 71.2% in the vertebroplasty group, and the mean recovery rate was -26.4% and +30.1%, respectively (p<.0001). One fracture in the vertebroplasty group showed delayed union until 6 months after injury. In the control group, there were six delayed union including four pseudoarthroses at over 6 months after injury that caused leg pain and were treated by conservative therapy.
  
  
  CONCLUSIONS
  We conclude that vertebroplasty after intravertebral cavity formation provided a better clinical and radiological result than conservative treatment for osteoporotic burst fracture.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan. Electronic address: mnakano-tym@umin.ac.jp.
authors.forename: Masato
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Kawaguchi
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan.
authors.forename: Tomoatsu
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Orthopaedic Surgery, Toyama Rosai Hospital, 992 Rokuroumaru, Uozu City, Toyama 937-0042, Japan.
authors.forename: Norikazu
authors.initials: N
authors.lastname: Hirano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D016022:Case-Control Studies; D005260:Female; D050815:Fractures, Compression / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000601:surgery / Q000628:therapy*; D016103:Spinal Fractures / Q000601:surgery / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*
chemical_list: D001843:Bone Cements
keywords: Burst fracture; Calcium phosphate cement; Osteoporosis; Vertebral fracture; Vertebroplasty