Bornemann R, Hanna M, Kabir K, Goost H, Wirtz C, Pflugmacher R. Euro Spine J 2012. Pubmed PMID: 22234722

BACKGROUND: There is controversy about how to treat vertebral fractures. Conservative care is the default approach. The aims of this study were to compare RF-TVA to conservative care and assess the usual algorithm of starting all patients on conservative care for 6 weeks before offering RF-TVA.

METHODS: Elderly patients with painful osteoporotic vertebral compression fractures were all treated with 6 weeks of conservative care (analgesics, bracing, and physiotherapy). They were then offered the choice of continuing conservative care or crossing over to radiofrequency kyphoplasty, at 6 and 12 weeks. Clinical success was defined as: (1) VAS pain improvement ≥2, (2) final VAS pain ≤5, (3) no functional worsening on ODI.

RESULTS: After the initial 6 weeks of conservative care, only 1 of 65 patients met the criteria for clinical success, and median pain VAS improvement was 0. After 12 weeks of conservative care, only 5 of 38 patients met the criteria for clinical success, and median pain VAS improvement was 1. After RF-TVA, 31 of 33 patients met the criteria for clinical success, and median pain VAS improvement was 5. Median range improvement in function ODI score was 38 (range 22-56). Cement leakage was only seen in 3 of 56 (5%) levels operated.

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CONCLUSION: For the vast majority of patients with a VAS ≥5, conservative care did not provide meaningful clinical improvement. In contrast, nearly all patients who underwent RF-TVA had rapid substantial improvement. RF-TVA was more effective than conservative care.