Abstract
Study Design: Prospective Cohort Study.
Objective: To describe the natural history of a cohort of patients with osteoporotic vertebral fractures treated conservatively with bedrest and a Taylor brace.
Summary of Background Data: Interest is growing in minimally invasive techniques to treat vertebral fractures in the elderly population. Amongst the benefits mooted are relief of pain and prevention of deformity. However limited background data is available concerning the long-term outcome of such patients treated conservatively.
Patients and Methods: All patients admitted to our institution over a five-year period following a vertebral fracture were identified (n=223) 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 SF-36 questionnaire were completed. Patients over 65 years, involved in minor trauma without neurological deficit were included. Patients over 65 years who were involved in major trauma or non-Irish residents were excluded from the study.
Results: Mean patient age at the time of injury was 72.1 years. 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 had died since their admission. According to family members none had any pain or neurological symptoms related to their spinal injuries. Forty patients attended the clinic for review while nine completed telephone questionnaires. 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 correlation existed between the magnitude of the initial vertebral collapse and the Oswestry or SF-36 scores. Physical Function and Bodily Pain subsets of SF-36 were no different to an age matched Irish population. 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.
Conclusion: This 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.
These abstracts were prepared by Mr. Brian J C Freeman FRCS (Tr & Orth). Correspondence should be addressed to him at The Centre for Spinal Studies and Surgery, University Hospital, Queens Medical Centre, Nottingham NG7 2UH.
