Abstract
Background: Interest is growing in minimally invasive techniques to treat fractures in the elderly population. Amongst the benefits mooted are relief of pain and prevention of deformity. However little background data is available concerning the long-term outcome of such patients treated by either conservative or surgical means.
Aim: To describe the natural history of a cohort of patients with osteoporotic vertebral fractures treated conservatively with bed rest and a Taylor brace.
Patients & Methods: All patients admitted to our institution over a five-year period following a vertebral fracture were identified. A total of 223 patients were admitted over the study period. Of these, 61 were suitable for inclusion in the study. Following departmental approval, all patients were contacted by phone and invited to participate in the study. Patients were examined in the clinic, plain radiographs were performed and the Oswestry pain score, a visual analogue pain score (VAS), and SF36 questionnaire were completed.
Inclusion Criteria:
Patients over 65years at time of injury
Minor trauma e.g. minor fall
No neurological deficit
Exclusion Criteria:
Patients over 65 years who were involved in major trauma.
Non-Irish residents
Results: Mean patient age at time of injury was 72.1years. Mean duration of follow up was 8.2 years with a minimum follow up of 5 years. Seven patients were lost to follow up. Of the remaining fifty-four patients, five died since their admission. According to family members, none had any pain or neurological symptoms related to their spinal injuries. Forth patients attended the clinic for review while nine completed telephone questionnaires. On examination, two patients had a clinically evident kyphosis. The mean range of anterior flexion was 78.9 + 15. The mean VAS pain score was 2.2 + 2.0. No significant corrleation existed between the magnitude of the initial vertebral collapse and the Oswestry of SF36 scores. No significant further vertebral collapse was noted on radiographic follow up. A small cohort of patients did develop chronic back pain. These patients’ outcome could not be predicted on the basis of initial radiographs.
Discussion: Our study supports conservative management: most patients recovered normal function and suffered little long-term pain. It was not possible to predict which patients would develop chronic back pain on the basis of initial radiographs. This calls into question the indications for undertaking vertebroplasty or kyphoplasty in the treatment of such patients.
The abstracts were prepared by Raymond Moran. Correspondence should be addressed to him at the Irish Orthopaedic Assocation, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
