Establishing Optimal Treatment for Osteoporotic Vertebral Fracture Based on Quantitative Evaluation of Vertebral Body Instability Using Dynamic Radiographs at Initial Visit
10.2185/jjrm.65.932
- VernacularTitle:初診時単純X 線動態撮影による椎体不安定性の定量評価に基づいた骨粗鬆症性椎体骨折の最適な治療法確立に向けた試み
- Author:
Toru FUNAYAMA
;
Toshinori TSUKANISHI
- Publication Type:Journal Article
- From:Journal of the Japanese Association of Rural Medicine
2017;65(5):932-939
- CountryJapan
- Language:Japanese
-
Abstract:
In a study involving 43 patients with osteoporotic vertebral fracture aged ≥ 65 years, three different therapeutic methods were designed based on a quantitative evaluation of vertebralbody instability that used dynamic radiographs taken at the initial visit. Vertebral body instability was defined as the difference between the percentage ratio of vertebral collapse (%) in the standing position and that in the supine position. When the difference was ≤ 5%, no bed rest was prescribed and ambulation was permitted as soon as a Jewett-type hard corset was ready (approximately 1 week). When the difference was between ＞5% and ＜20%, 2 weeks of bed rest was prescribed, after which ambulation while wearing the corset was permitted. When the difference was ≥ 20%, 2 weeks of bed rest was prescribed followed by ambulation, but when pain persisted or rehabilitation showed no progress, treatment was changed to surgery. At 3 months after starting treatment, bone union, degree of improvement of pain, activities of daily living, and quality of life were evaluated. Findings showed that almost satisfactory treatment outcomes were achieved with all three treatment approaches. These findings suggest that while priority should be given to conservative treatment based on a quantitative evaluation of vertebral body instability, the possibility of surgery should also be considered. Particularly in cases with ≥ 20% difference in the percentage ratio of vertebral collapse, surgical interventionat a relatively early stage may help reduce to zero the potential for delayed union, pseudarthrosis, and delayed paralysis.
