Shahmir Kamalian

Osteoporotic vertebral compression fractures are a major cause of morbidity and mortality in the elderly population, causing considerable pain and disability, which lead to a substantial decline in quality of life. Multiple studies, including randomized controlled trials, have shown the beneficial effects of vertebral augmentation when compared with conservative non-surgical management. However, some patients may continue to experience substantial back pain after their vertebral augmentation procedure. In certain instances this may be due to a new painful vertebral compression fracture. In other situations, the recurrence or persistence of back pain is simply attributed to a failed procedure. To our knowledge, prior studies have not examined the specific causes of persistent back pain in these patients.

At our institution, we have a clinic where all patients are routinely followed up 3 weeks, 3 months, and a year after vertebral augmentation. During follow-up visits it was noted that some patients were returning with complaints of either persistent or new pain. After detailed physical and fluoroscopic examinations, it was discovered that many of these patients were experiencing pain related to other pain generators in the spine, and not related to their treated fractures. For example, a patient who underwent lumbar vertebral augmentation could be returning with pain related to lumbar facet or sacroiliac joint arthropathy or inflammation. We found that in many instances patients had other treatable causes for their back symptoms and, hence, we were able to favorably intervene on their behalf.

Our findings highlight the importance of regular follow-up and comprehensive physical examination, along with questionnaires and subjective assessments in this at-risk population. This is especially important because postprocedural pain may not necessarily reflect failure or a lack of efficacy of the vertebral augmentation procedure, as suggested by two recent trials. Vertebral compression fractures are associated with compromise of not only the involved vertebral body but the adjacent components of the spinal unit, including the load-bearing joints, facet and sacroiliac, spinal ligaments, and muscles. Continued data collection can also be used to help compare the long-term efficacy of vertebral augmentation with other, non-surgical management options.

Read this article at AJNR.org . . .