Comparison of Vertebroplasty Versus Vertebral Perforation for the Treatment of Acute Vertebral Compression Fractures.

of vertebroplasty, a possible placebo effect of vertebroplasty could not be ruled out (6,11,16,20,21). Firanescu et al. are conducting a randomized controlled trial targeting patients with acute VCFs to compare vertebroplasty and a sham procedure without cement injection, and their trial has not yet reached a conclusion (12). Vertebral perforation for VCFs is a procedure in which an affected vertebral body is perforated but not injected with bone cement (26,27). This procedure is contrived based on a hypothesis that fracture pain is caused by hyper-intraosseous pressure, and the aim of the procedure is to relieve pain by █ INTRODUCTION Percutaneous vertebroplasty for painful vertebral compression fractures (VCFs) is performed worldwide mainly for patients in the chronic phase because this procedure has effects on immediate pain relief and improvement in the patients’ activities of daily living (ADL) (7,13-16,20,25). However, there is very little evidence regarding the application of vertebroplasty to acute VCFs at present, and vertebroplasty is not an established treatment procedure (6,11,12,16,20,21,23). As vertebroplasty was compared to conservative therapy in most of the previous comparative studies on the usefulness AIm: The efficacy of vertebroplasty on acute vertebral compression fractures (VCFs) has not yet been established. This study, focusing on patients with acute VCFs, aims to compare therapeutic effects between vertebroplasty and vertebral perforation without cement injection. mATERIAl and mEThODS: Fifty-five patients with single painful VCFs were assigned to undergo vertebroplasty (Vertebroplasty group; 28 patients) or vertebral perforation (Perforation group; 27 patients). Analgesic effects before and after surgery were compared between 2 groups. Furthermore, the frequency of new VCFs during the follow-up period was compared. RESUlTS: In both groups, the visual analog scale (VAS) scores markedly decreased immediately after surgery and remained low until 90 days after surgery (p<0.05). However, in the Perforation group, the analgesic effect from postoperative day 7 to 90 was significantly lower in patients with vertebral mobility before surgery than those without mobility (p<0.05). New fractures after surgery occurred in 12 (42.9%) of the 28 patients in the Vertebroplasty group and 8 (29.6%) of the 27 patients in the Perforation group (p =0.054). CONClUSION: In acute VCFs, vertebroplasty exerts a marked analgesic effect, which does not differ much from that of vertebral perforation without cement injection. Considering the risk of new postoperative fractures, the application of bone cement infusion should be carefully considered in patients with acute VCF. KEywORDS: Acute vertebral compression fracture, Vertebral perforation procedure, Vertebroplasty