Clinical course of pain in acute osteoporotic vertebral compression fractures.

Department of Radiology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, Tilburg, NL 5022 GC, The Netherlands.
Journal of vascular and interventional radiology: JVIR (Impact Factor: 1.81). 09/2010; 21(9):1405-9. DOI: 10.1016/j.jvir.2010.05.018
Source: PubMed

ABSTRACT The authors prospectively determined the natural course of pain in patients with conservatively treated acute osteoporotic vertebral compression fractures (VCF). In addition, the type of conservative therapy that these patients received was assessed.
Patients older than 50 years, referred for spine radiography for acute back pain, were asked to complete a baseline clinical questionnaire. Patients with an acute VCF were followed up at 6 and 23 months with a questionnaire that included a Visual Analog Score (VAS) and type of pain medication and other conservative treatment. Significant pain relief was defined as a decrease in VAS of 50% or more.
Forty-nine patients (mean age, 78 years; range, 51-95) with acute VCF were followed up for almost 2 years. Significant pain relief was noted in 22 of 35 patients (63%) at 6 months and in 25 of 36 (69%) at 23 months. In patients with persisting pain at 23 months (mean VAS 6.4), some decrease in VAS was apparent at 6 months but not in the 6-23 months interval. No predictors for significant pain relief could be identified. Patients with significant pain relief used less pain medication and had less physical therapy.
In most patients with an acute VCF, pain decreases significantly with conservative therapy, predominantly in the first 6 months. However, almost 2 years after an acute VCF, a third of patients still had severe pain necessitating pain medication and physical therapy in the majority. No predictors for transition from acute to chronic pain could be identified.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Dynamic radiographs are recommended to investigate non-healing evidence such as the dynamic mobility or intravertebral clefts in osteoporotic vertebral compression fractures (VCFs). However, it is difficult to examine standing flexion and extension lateral radiographs due to severe pain. The use of prone cross-table lateral radiographs (PrLRs) as a diagnostic tool has never been proposed to our knowledge. The purpose of this study is to clarify the usefulness of PrLRs in diagnosis and treatment of VCFs. We reviewed 62 VCF patients examined with PrLRs between January 1, 2008 and June 30, 2011. To compare the degree of pain provoked between standing extension lateral radiographs (StLRs) and PrLRs, numeric rating scale (NRS) scores were assessed and compared by a paired t-test. Vertebroplasty was done for 40 patients and kyphoplasty was done for 9 patients with routine manners. To assess the degree of postural reduction, vertebral wedge angles (VWA) and vertebral height ratios (VHR) were calculated by using preoperative StLRs, PrLRs, and postoperative lateral radiographs. Two variables derived from changes in VWA and VHR between preoperative and postoperative radiographs were compared by a paired t-test. The average NRS scores were 6.23 ± 1.67 in StLRs and 5.18 ± 1.47 in PrLRs. The degree of pain provocation was lower in using PrLRs than StLRs (p < 0.001). The average changes of VWA between preoperative and postoperative status were 5.24° ± 6.16° with PrLRs and 3.46° ± 3.47° with StLRs. The average changes of VHR were 0.248 ± 0.178 with PrLRs and 0.148 ± 0.161 with StLRs. The comparisons by two variables showed significant differences for both parameters (p = 0.021 and p < 0.001, respectively). The postoperative radiological status was reflected more precisely when using PrLRs than StLRs. In comparison with StLR, the PrLR was more accurate in predicting the degree of restoration of postoperative vertebral heights and wedge angles, and provoked less pain during examination. The PrLR could be a useful diagnostic tool to detect intravertebral cleft or intravertebral dynamic instability.
    Clinics in orthopedic surgery 09/2013; 5(3):195-201.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To report a serious complication of the StaXx FX system used to stabilize an osteoporotic vertebral fracture. A 76-year-old woman presented with a painful vertebral fracture. Treatment by means of a PEEK wafer kyphoplasty was complicated by malposition of the wafers. The patient recovered fully after removal of the wafers by means of a thoracotomy. New treatment modalities have their own pitfalls and possible complications, as demonstrated in this case report. Caution regarding implementation of new treatment modalities should be practiced.
    European Spine Journal 11/2011; 21 Suppl 4:S445-9. · 2.47 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To chronicle the conservative treatment and management of an osteoporotic patient presenting with acute back pain resulting from a lumbar compression fracture. A 74-year old male presented with acute back pain in the thoracolumbar region after an episode of lifting. Radiographic evaluation revealed generalized demineralization and a moderate wedge compression fracture at L1. The conservative treatment approach included postural education, activity modification, interferential current, taping into extension, Graston Technique(®), and rehabilitative exercise prescription. Outcome measures included verbal pain rating scale, medication use, and a return to activities of daily living (ADLs). The patient attained long-term symptom resolution with no recurrence of pain at 12 month follow-up. A combination of conservative rehabilitation strategies may be successfully implemented to treat osteoporotic patients with mild to moderate osteoporotic vertebral compression fracture of the lumbar spine.
    JCCA. Journal of the Canadian Chiropractic Association. Journal de l'Association chiropratique canadienne 03/2012; 56(1):29-39.

Full-text (2 Sources)

Available from
May 28, 2014