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Early mobilization, rigid fixation after vertebral compression fractures reduces vertebral deformity
Rigid bracing may help prevent the progression of vertebral deformity following fractures at T11 to L2.
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GOTHENBURG, Sweden — Bedrest leads to slightly more nonunions than two other conservative approaches for treating osteoporotic thoracolumbar vertebral compression fractures, according to a study recently presented by Japanese investigators.
The study is one of the first level 1 trials to compare the clinical and radiographic results of Japanese women who sustained acute vertebral compression fractures (VCFs).
After 3 weeks of bedrest, 14 patients in group 1 ambulated for the next 9 weeks wearing a semi-rigid brace. The 15 patients in group 2 underwent early mobilization and casting for 4 weeks, and then wore a simi-rigid brace. The 14 patients in group 3 ambulated immediately and wore a ready-made corset.
“This was a pilot study, and the number of patients is too small to draw a conclusion,” Kazuhiro Chiba, MD, of Tokyo, said at the International Society for the Study of the Lumbar Spine Annual Meeting 2011. “What we can say from this study is whatever you do, early intervention leads to acceptable clinical results even if the patient develops a nonunion.”
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He noted that fracture healing tends to be delayed if bedrest is the main treatment modality used.
Six inclusion criteria
The study group consisted of female patients without neurological deficits between the ages of 65 years and 90 years old who had fresh VCFs that occurred from T11 to L2 and were diagnosed using radiographs and MRI.
“The purpose of this study is to establish an optimum conservative treatment strategy,” according to Chiba.
To confirm the fracture healing in all groups, investigators repeated the radiographs and MRIs and used the presence of union vs. nonunion on radiographs or MRIs and progression of vertebral deformity on radiographs as the primary endpoints of their study. Pain on the Visual Analog Scale, SF-36 scores and neurological status were secondary study endpoints.
Motion on dynamic radiographs or clear, high T2 or T1 signals on MRI typically indicated a nonunion, Chiba said.
Deformity results
Patients in all groups were similar concerning age and the vertebral levels of their fractures. Regarding averaged results at 40-weeks follow-up, “The overall union rate was 63%, which is not very high,” Chiba said, attributing this perhaps to the strict radiographic criteria.
“The bedrest group tends to have slower union, but catches up at 48 weeks,” but this was not statistically different than in the other two groups, he noted.
Based on the quantified analysis of progression of vertebral deformity on lateral radiographs, vertebral wedging rates were lowest in group 2 patients who wore the most rigid braces. Vertebral wedging occurred within 4 weeks to 8 weeks. Study results showed that SF-36 scores tended to be superior in group 2 vs. group 1. – by Susan M. Rapp
Reference:
- Chiba K, Yoshida M, Shinomiya K, et al. Conservative managements for osteoporotic thoracolumbar vertebral compression fractures — A multicenter prospective RCT. Paper #P63. Presented at the International Society for the Study of the Lumbar Spine Annual Meeting 2011. June 14-18. Gothenburg, Sweden.
- Kazuhiro Chiba, MD, can be reached at the Department of Orthopaedic Surgery, Keio University, Tokyo, Japan; +81-3-5363-3812; email: kchiba@sc.itc.keio.ac.jp.
- Disclosure: The research was fully supported by the Japanese Orthopaedic Association Research Project Fund.