Osteoporotic thoracolumbar compression fractures: long-term retrospective comparison between vertebroplasty and conservative treatment

Purpose: To compare long term clinical and radiographic outcomes in osteoporotic vertebral compression fractures of the thoracolumbar spine treated with conservative treatment and percutaneous vertebroplasty. Methods: The retrospective study with inclusion criteria focused on osteoporotic fractures of the thoracolumbar junction (T10–L2). Clinical outcomes were evaluated by using the VAS, Oswestry and SF36 questionnaires. Radiographic outcomes were evaluated by comparing the following sagittal parameters: body angle, sagittal index of fractured vertebral body and adjacent vertebral segments kyphosis. Complications in terms of adjacent vertebral fractures and cement leakage are reported. Results: Percutaneous vertebroplasty provided better vertebral body height restoration, but was associated with a higher incidence of adjacent fractures (20%) than conservative treatment (3.5%). This fact may explain why patients treated with percutaneous vertebroplasty had worse overall kyphotic alignment at final follow-up. Cement leakage was frequent, but always asymptomatic and generally no serious complications occurred. Conclusions: Percutaneous vertebroplasty represents a safe treatment for osteoporotic vertebral compression fractures, although it may be associated with a higher incidence of adjacent fractures and therefore worse thoracolumbar kyphosis and long-term follow-up than conservative treatment. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].