When is vertebroplasty indicated for acute compression fractures?

From the Guidelines

**Vertebroplasty is indicated for acute vertebral compression fractures when patients have severe, debilitating pain that fails to respond to conservative management, particularly in those with acute osteoporotic VCF of <6 weeks’ duration, as it has been shown to be superior to placebo intervention for pain reduction in such cases**. The decision to perform vertebroplasty should be based on the individual patient's condition, taking into account the severity of pain, the duration of symptoms, and the presence of any contraindications. According to the study by Syed et al 1, patients with VCF >12 weeks compared to those with VCFs <12 weeks had equivalent benefit, suggesting that the age of the fracture does not independently affect the outcomes of vertebroplasty.

Some key points to consider when evaluating a patient for vertebroplasty include:

• The patient's pain should be severe and debilitating, and should not have responded to conservative management, including analgesics, bed rest, and bracing 1
• The fracture should be acute, with a duration of less than 6 weeks, although benefits have been shown in fractures up to 12 weeks old 1
• The patient should have localized pain that correlates with the fracture site on imaging 1
• Contraindications to vertebroplasty include active infection, coagulopathy, spinal cord compression, or fractures extending into the spinal canal 1

The procedure involves injecting bone cement into the fractured vertebral body to stabilize the fracture and provide pain relief. Most patients experience significant pain relief within 24-72 hours after the procedure. It is essential to weigh the potential benefits of vertebroplasty against the potential risks and to consider alternative treatment options, such as conservative management or other interventions, on a case-by-case basis. As noted in the study by Evans et al 1, vertebroplasty and kyphoplasty are equally effective in substantially reducing pain and disability in patients with VCF.

In terms of the timing of when vertebroplasty is appropriate, the threshold for performing vertebroplasty has declined, and it may be considered earlier in patients with intractable pain despite optimal medical therapy. The study by Syed et al 1 found that VA was superior to placebo intervention for pain reduction in patients with acute osteoporotic VCF of <6 weeks’ duration. Additionally, a meta-analysis found improvements in pain intensity, vertebral height, sagittal alignment, functional capacity, and quality of life with kyphoplasty as compared with conventional medical management 1.

Overall, the decision to perform vertebroplasty should be based on a thorough evaluation of the patient's condition and a consideration of the potential benefits and risks of the procedure. Vertebroplasty is a valuable treatment option for patients with acute vertebral compression fractures who have failed conservative management, and it can provide significant pain relief and improvement in functional outcomes.

From the Research

Indications for Vertebroplasty in Acute Compression Fractures

Vertebroplasty is indicated for acute compression fractures in the following situations:

• Patients with acute vertebral compression fractures (≤6 weeks old) who have not achieved adequate pain relief using conservative measures alone 2
• Patients with osteoporotic compression fractures who experience persistent severe pain and limited mobility despite conservative therapy 3
• Patients with acute osteoporotic vertebral compression fractures and persistent pain, where percutaneous vertebroplasty has been shown to be effective and safe 4

Key Considerations

When considering vertebroplasty for acute compression fractures, the following points are important:

• Vertebroplasty represents an alternative treatment option for vertebral compression fractures, particularly for patients who have not responded to conservative measures 2
• The procedure involves a percutaneous injection of bone cement into the collapsed vertebrae under fluoroscopic imaging guidance 3
• High-quality studies have reported conflicting results regarding the use of vertebroplasty in the treatment of acute vertebral compression fractures, but pooled data from RCTs suggest that vertebroplasty is safe 2
• Vertebroplasty has been shown to provide immediate and significant pain relief, as well as improvements in physical functioning and reduced medication requirements, compared to conservative therapy 4, 5

Patient Selection

The following patient characteristics may be indicative of a good candidate for vertebroplasty:

• Age 50 years or older
• Vertebral compression fractures on spine radiograph (minimum 15% height loss; level of fracture at Th5 or lower; bone oedema on MRI)
• Back pain for 6 weeks or less
• Visual analogue scale (VAS) score of 5 or more 4