HNY Policy and Pathway Repository - North Lincolnshire

Painful osteoporotic vertebral fractures

These interventions are commissioned if:

• patients have severe (7/10 or greater on VAS scale) ongoing pain after a recent (usually not more than 6 weeks), unhealed vertebral fracture despite optimal pain management AND
• the acute vertebral fracture has been proven on imaging and correlates with the site of maximal pain on clinical examination AND
• the decision to treat is recommended following multidisciplinary team review AND
• the procedure takes place at a facility with access to spinal surgery services AND

VP/KP are performed in conjunction with additional measures to improve bone health.

The evidence for these interventions has been heterogenous and resulted in conflicting conclusions. A Cochrane systematic review in 2018 concluded that evidence did not support the use of VP in painful osteoporotic fractures, but NICE TA 279 recommended its use and publications since 2016 have shown a reduction in mortality and reduction in length of inpatient stay in those treated with VA as opposed to conservative management.  Risk of serious adverse event following VA is rare. VA has not shown to cause an increase in additional/adjacent vertebral fractures.

 

In view of the ongoing lack of conclusive evidence, processes for audit and clinical governance should be in place where the interventions are provided.

Vertebral augmentation for painful osteoporotic vertebral fractures (EBI)

TA279 Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures (NICE)

Percutaneous vertebroplasty for osteoporotic vertebral compression fracture - Buchbinder, R - 2018 | Cochrane Library