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. 2022 Sep;45(9):1314-1321.
doi: 10.1007/s00270-022-03170-7. Epub 2022 Jun 9.

Predictive Factors for Sustained Pain after (sub)acute Osteoporotic Vertebral Fractures. Combined Results from the VERTOS II and VERTOS IV Trial

Cristina E Firanescu  1   2 , Alexander Venmans  3 , Jolanda de Vries  4   5 , Paul Lodder  5 , Marinus C Schoemaker  3 , Albert J Smeets  3 , Esther Donga  3 , Job R Juttmann  3 , Karen Schonenberg  3 , Caroline A H Klazen  6 , Otto E H Elgersma  7 , Frits H Jansen  8 , Hendrik Fransen  9 , Joshua A Hirsch  10 , Paul N M Lohle  3
Affiliations

Predictive Factors for Sustained Pain after (sub)acute Osteoporotic Vertebral Fractures. Combined Results from the VERTOS II and VERTOS IV Trial

Cristina E Firanescu et al. Cardiovasc Intervent Radiol. 2022 Sep.

Abstract

Purpose: Osteoporotic vertebral compression fractures are treated conservatively or in selected cases with percutaneous vertebroplasty (PV). The purpose of this retrospective analysis is to determine predictive factors for a high visual analogue scale (VAS) pain score after conservative, sham or PV and is based on previously published randomized trials.

Methods: The VERTOS II compared conservative versus PV, and VERTOS IV compared sham versus PV treatment. The conservative group received pain medication. The sham and PV group received subcutaneous lidocaine/bupivacaine. In addition, the PV group received cementation, which was simulated in the sham group. Nineteen different predictors of high (≥ 5) versus low (< 5) VAS pain score at 12 months were investigated.

Results: 20.7% of patients in the PV group demonstrated a VAS ≥ 5 at the 12-month, compared to 40.1% in the conservative or sham group, with a significant difference (χ2(1) = 15.26, p < 0.0001, OR = 2.57, 95% CI = 1.59 to 4.15). In the subgroup analysis, we detected five predictors for the risk of high pain scores (VAS ≥ 5 after 12 months follow-up), namely: female, baseline VAS > 8, long-term baseline pain, mild/severe Genant and new fractures.

Conclusions: Statistically significant more patients had a high pain score at 12 months in the sham and conservative group when compared with the PV group. Five predictors were identified for sustained high local back pain, regardless of the received treatment. Patients with moderate fracture deformity were less likely to have high pain scores at 12 months if they received PV than if they had sham or conservative therapy.

Keywords: Osteoporotic vertebral compression fracture (OVCF); Percutaneous vertebroplasty (PV); Polymethylmethacrylate (PMMA); Visual analogue scale (VAS).

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Conflict of interest statement

We declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. JAH has received consulting fees from Medtronic and Globus as well as serving on a data and safety monitoring board of a study sponsored by Codman Neurovascular.

Figures

Fig. 1
Fig. 1
The percentage of patients with VAS ≥ 5 during the 12-month follow-up outlined for each type of treatment
Fig. 2
Fig. 2
Forest plots showing for each study and treatment the effect of five predictors on having VAS ≥ 5 at 12-month follow-up
See this image and copyright information in PMC

Comment in

References

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