A study recently published in the American Journal of Neuroradiology by Robert J McDonald, Department of Radiology, Mayo Clinic, Rochester, USA et al finds that patients who receive vertebroplasty show similar mortality rates to those individuals with symptomatic vertebral compression fractures who have not been treated at all.
Additionally, the researchers also found that vertebroplasty recipients have worse mortality compared with those who had asymptomatic vertebral fractures.
The researchers write that vertebroplasty is an effective treatment for painful compression fractures refractory to conservative management. They also clarify that there are limited data regarding the survival characteristics of this patient population. So the investigators compared the survival of a treated with an untreated vertebral fracture cohort to determine whether vertebroplasty affects mortality rates.
McDonald et al compared the survival of a group comprising 524 vertebroplasty recipients with refractory osteoporotic vertebral compression fractures, with a separate historical cohort of 589 subjects with fractures that were not treated by vertebroplasty who were identified from the Rochester Epidemiology Project.
They used Cox proportional hazards models adjusting for age, sex, and Charlson indices of comorbidity to compare mortality between the two groups. The researchers also correlated mortality with pre-, peri-, and postprocedural clinical metrics (eg, cement volume use, Roland-Morris Disability score, analog pain scales, frequency of narcotic use, and improvement in mobility) within the group that received vertebroplasty.
Results
The Mayo group researchers found that individuals who were treated by vertebroplasty demonstrated 77% of the survival expected for individuals of similar age, ethnicity, and sex within the US population. When the group treated by vertebroplasty was compared with individuals with both symptomatic and asymptomatic untreated vertebral fractures, vertebroplasty recipients had a 17% greater mortality risk. However, the researchers noted that when compared with a group who had symptomatic untreated vertebral fractures, vertebroplasty recipients had no increased mortality following adjustment for differences in age, sex, and comorbidity (HR, 1.02; 95% CI, 0.82–1.25). “In addition, no clinical metrics used to assess the efficacy of vertebroplasty were predictive of survival,” they wrote.
