Because of improved alignment and decreased pain, VA has been shown to improve pulmonary function in patients with VCF [89,123,124,140]. Certain newer variants of VA are shown to be comparable to standard methods, such as BK, for decreased pain score, functional improvement, and height restoration [17,141]. The timing of when VA is useful has been debated. In the VERTOS II trial, of the patients who had significant pain relief on medical management, the majority achieved this level by 3 months; this study suggested that patients who had not received sufficient pain relief by 3 months with conservative treatment may be candidates for VA [34]. Studies have found VA to be superior to placebo intervention for pain reduction in patients with acute osteoporotic VCF of <6 weeks duration [22]. As noted in Variant 1 in the study by Syed et al [33], patients with VCF >12 weeks compared with VCF <12 weeks had equivalent benefit suggesting that the age of the fracture does not independently affect the outcomes of VA, although there is evidence for treatment of subacute and chronic, painful compression fractures [21,23,31,32]. Vertebral Compression Fractures position that BK or VP may be considered to be useful and generally interchangeable techniques for the performance of VA [36]. Percutaneous Ablation Spine Percutaneous thermal ablation procedures are reserved for symptomatic spinal metastatic disease [112]. Surgical Consultation Surgical intervention is reserved for patients with neurologic deficits or spinal instability. When the etiology of the VCF is questionable and percutaneous biopsy is not feasible, an open biopsy may be necessary. Surgical consultation can assist in prescribing and supervising immobilization devices. Radiation Oncology Consultation There is no role for RT in a patient without a cancer diagnosis and a nonpathologic VCF. If cancer is thought to be the cause of a VCF, then a biopsy is needed to confirm a cancer diagnosis.
Management of Vertebral Compression Fractures PCAs. Because of improved alignment and decreased pain, VA has been shown to improve pulmonary function in patients with VCF [89,123,124,140]. Certain newer variants of VA are shown to be comparable to standard methods, such as BK, for decreased pain score, functional improvement, and height restoration [17,141]. The timing of when VA is useful has been debated. In the VERTOS II trial, of the patients who had significant pain relief on medical management, the majority achieved this level by 3 months; this study suggested that patients who had not received sufficient pain relief by 3 months with conservative treatment may be candidates for VA [34]. Studies have found VA to be superior to placebo intervention for pain reduction in patients with acute osteoporotic VCF of <6 weeks duration [22]. As noted in Variant 1 in the study by Syed et al [33], patients with VCF >12 weeks compared with VCF <12 weeks had equivalent benefit suggesting that the age of the fracture does not independently affect the outcomes of VA, although there is evidence for treatment of subacute and chronic, painful compression fractures [21,23,31,32]. Vertebral Compression Fractures position that BK or VP may be considered to be useful and generally interchangeable techniques for the performance of VA [36]. Percutaneous Ablation Spine Percutaneous thermal ablation procedures are reserved for symptomatic spinal metastatic disease [112]. Surgical Consultation Surgical intervention is reserved for patients with neurologic deficits or spinal instability. When the etiology of the VCF is questionable and percutaneous biopsy is not feasible, an open biopsy may be necessary. Surgical consultation can assist in prescribing and supervising immobilization devices. Radiation Oncology Consultation There is no role for RT in a patient without a cancer diagnosis and a nonpathologic VCF. If cancer is thought to be the cause of a VCF, then a biopsy is needed to confirm a cancer diagnosis.