Osteoporotic vertebral fractures in elderly patients are common. If symptoms are mild, they are usually treated conservatively. However, in cases of marked pain, percutaneous vertebroplasty (PVP) may be useful in the acute stage.
Introduction: Osteoporotic vertebral fractures in elderly patients are common and are usually treated conservatively when symptoms are mild. However, in cases of pronounced pain symptoms, percutaneous vertebroplasty (PVP) may be useful in the acute stage.
Case description: A 64-year-old patient with known epilepsy since childhood fell with his back on a stair step during an epileptic seizure. Subsequently, a pronounced lumbar pain symptomatology occurred. A conventional radiograph showed minimal cover plate impression (Fig. 1) . MRI showed without doubt an acute compression fracture of BWK 12 (type A1 according to the AO classification) (Fig. 2A and B), and osteodensitometry showed osteopenia. Due to the immobilizing pain despite morphine medication, PVP was indicated four days after the trauma. A good filling of the fracture gap and adjacent bone was achieved via a unilateral transpedicular approach (Fig. 2C and D). Immediately after PVP, the patient showed improvement in pain symptoms; after two days, pain medication could be discontinued, and after another two days, the patient could be discharged.
CONCLUSION: In a recently published prospective randomized multicenter study, PVP was shown to be significantly superior to a placebo intervention in acute vertebral fractures (less than six weeks) in terms of pain reduction [1]. In a subgroup analysis, this was particularly true for fractures – as described here – in the thoracolumbar region.
The minimally invasive procedure can not only effectively treat pain, but especially reduce the side effects of conservative therapy (consequences of long-term immobilization and pain medication). In patients who are often polymorbid, the indication must be discussed on an interdisciplinary basis.
Literature:
- Clark W, et al: Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016; 388: 1408-1416.
InFo NEUROLOGY & PSYCHIATRY 2018; 16(1): 40-41.
