Top

Published in:

Open Access 01-12-2018 | Original Article

Initial hospitalization with rigorous bed rest followed by bracing and rehabilitation as an option of conservative treatment for osteoporotic vertebral fractures in elderly patients: a pilot one arm safety and feasibility study

Authors: Tetsuya Abe, Yosuke Shibao, Yosuke Takeuchi, Yuki Mataki, Kuniaki Amano, Shigeru Hioki, Kousei Miura, Hiroshi Noguchi, Toru Funayama, Masao Koda, Masashi Yamazaki

Published in: Archives of Osteoporosis | Issue 1/2018

Abstract

Summary

We assessed the safety and feasibility of a unified conservative treatment protocol for osteoporotic vertebral fractures in the elderly patients with a 24-week follow-up. Our results showed that initial hospitalization with rigorous bed rest followed by a rehabilitation program using a Jewett brace was safe and feasible in managing patients.

Purpose

The purpose of this study was to prove the safety and feasibility of a unified conservative treatment protocol, which included initial hospitalization with rigorous bed rest followed by a rehabilitation program with Jewett brace for osteoporotic vertebral fractures (OVFs) in the elderly patients with a 24-week follow-up.

Methods

Between April 2012 and Mach 2015, one hundred fifty-four patients met the eligibility for this study. Radiological findings at the 3-week, 6~8-week, 24-week assessment were evaluated. Among these, 11 patients underwent early surgery within the first 2 weeks after admission and 19 patients lost follow-up. Therefore, 124 patients were assessed at the final follow-up visit.

Results

The average vertebral instability in all the present series was 4.9 ± 4.8° at 3-week, 2.9 ± 3.5° at 6~8-week, and 1.8 ± 3.0° at 24-week follow-up visit. Delayed union was observed in 16 patients on the 24-week follow-up visit. Therefore, the present conservative treatment protocol resulted in bony union in 98 out of 124 patients (79.0%, per protocol set analysis) and 98 out of 154 patients including drop-out (63.6%, intention-to-treat analysis). There was no severe adverse event related to initial bed rest. The vertebral instability at 3-week assessment was significantly higher in the delayed union group when compared with that in the union group. Univariate analyses followed by multivariate logistic regression analysis revealed that T2-weighted image of confined high intensity on MRI and having more than 5° of vertebral instability on dynamic X-ray at 3-week assessment are the independent risk factors for delayed union of conservative treatment in the present series.

Conclusions

Our results showed that initial hospitalization with rigorous bed rest followed by a rehabilitation program using a Jewett brace was safe and feasible. Therefore, the present conservative treatment protocol can be one of the acceptable treatment options in managing OVF patients.

Ann Y, Lee JH, Lee HY, Lee SH, Keem SH (2008) Predictive factors for subsequent vertebral fracture after percutaneous vertebroplasty. J Neurosurg Spine 9:129–136CrossRef

Ataka H, Tanno T, Yamazaki M (2009) Posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine. Eur Spine J 18:69–76CrossRef

Farrokhi MR, Alibai E, Maghami Z (2011) Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression fractures. J Neurosurg Spine 14:561–569CrossRef

Graham HK, Harvey A, Rodda J, Nattrass GR, Pirpiris M (2004) The functional mobility scale (FMS). J Pediatr Orthop 24:514–520CrossRef

Glassman SD, Bridwell K, Dimer JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029CrossRef

Goodwin VA, Hall AJ, Rogers E, Bethel A (2016) Orthotics and taping in the management of vertebral fractures in people with osteoporosis: a systematic review. BMJ Open 6:e010657. https://doi.org/10.1136/bmjopen-2015-010657 CrossRefPubMedPubMedCentral

Hasegawa H, Homma T, Uchiyama S, Takahashi H (1998) Vertebral pseudarthrosis in the osteoporotic spine. Spine 23:2201–2206CrossRef

Hagino H (2012) Locomotive syndrome and frailty. Osteoporosis as an underlying disorder in the locomotive syndrome. Clin Calcium 22:41–48PubMed

Hoshino M, Nakamura H, Terai H, Tsujio T, Nabeta M, Namikawa T, Matsumura A, Suzuki A, Takayama K, Takaoka K (2009) Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture. Eur Spine J 18:1279–1286CrossRef

10.

Hoshino M, Tsujio T, Terai H, Namikawa T, Kato M, Matsumura A, Suzuki A, Takayama K, Takaoka K, Nakamura H (2013) Impact of initial conservative treatment interventions on the outcomes of patients with osteoporotic vertebral fractures. Spine 38:E641–E648CrossRef

11.

Kim DY, Lee SH, Jang JS, Chung SK, Lee HY (2004) Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of intravertebral instability. J Neurosurg 100:24–41CrossRef

12.

Kim HJ, Yi JM, Cho HY, Chang BS, Lee CK, Kim JH, Yeom JS (2014) Comparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: a prospective randomized controlled non-inferiority trial. J Bone Joint Surg 96:1959–1966CrossRef

13.

Kishikawa Y (2012) Initial non-weight-bearing therapy is important for preventing vertebral body collapse in elderly patients with clinical vertebral fractures. Int J Gen Med 5:373–380CrossRef

14.

Lungo UG, Loppini M, Denaro L, Maffulli N, Denaro V (2012) Conservative management of patients with an osteoporotic vertebral fracture: a review of the literature. J Bone Joint Surg Br 94:152–157CrossRef

15.

McGuire R (2011) AAOS clinical practice guideline: the treatment of symptomatic osteoporotic spinal compression fractures. J Am Acad Orthop Surg 19:183–184CrossRef

16.

Murata K, Watanabe G, Kawaguchi S, Kanaya K, Horigome K, Yajima H, Morita T, Yamashita T (2012) Union rates and prognostic variables of osteoporotic vertebral fractures treated with a rigid external support. J Neurosurg Spine 17:469–475CrossRef

17.

Nagad P, Rawall S, Kundnani V, Mohan K, Patil SS, Nene A (2012) Postvertebroplasty instability. J Neurosurg Spine 16:387–393CrossRef

18.

Newman M, Minns LC, Barker K (2016) Spinal orthoses for vertebral osteoporosis and osteoporotic vertebral fracture: a systematic review. Arch Phys Med Rehabil 97:1013–1025. https://doi.org/10.1016/j.apmr.2015.10.108 CrossRefPubMed

19.

Niimi R, Kono T, Nishida A, Hasegawa M, Matsumine A, Kono T, Sudo A (2014) Efficacy of the dynamic radiographs for diagnosing acute osteoporotic vertebral fractures. Osteoporos Int 25:605–612CrossRef

20.

Parreira PCS, Meher CG, Megale RZ, March L, Ferreiara ML (2017) An overview of clinical guidelines for the management of vertebral compression fracture: a systematic view. The Spine J 17:1932–1938CrossRef

21.

Saita K, Hoshino Y, Kikkawa I, Nakamura H (2000) Posterior spinal shortening for paraplegia after vertebral collapse caused by osteoporosis. Spine 25:2832–2835CrossRef

22.

Suk SO, Kim JH, Lee SM, Chung ER, Lee JH (2003) Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine 28:2170–2175CrossRef

23.

Tsujio T, Nakamura H, Terai H, Hoshino M, Namikawa T, Matsumura A, Kato M, Suzuki A, Takayama K, Fukushima W, Kondo K, Hirota Y, Takaoka K (2011) Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral fractures predicting potential risk of nonunion. Spine 36:1229–1235CrossRef

24.

Wu CT, Lee SC, Lee ST, Chen JF (2006) Classification of symptomatic osteoporotic compression fractures of the thoracic and lumbar spine. J Clin Neurosci 13:31–38CrossRef

25.

Yagi H, Togami K, Suemura M, Tominaga T, Matsushima T, Kido K (2014) Japanese society occupational medicine. Traumatology 62:179–183

Title: Initial hospitalization with rigorous bed rest followed by bracing and rehabilitation as an option of conservative treatment for osteoporotic vertebral fractures in elderly patients: a pilot one arm safety and feasibility study
Authors: Tetsuya Abe
Yosuke Shibao
Yosuke Takeuchi
Yuki Mataki
Kuniaki Amano
Shigeru Hioki
Kousei Miura
Hiroshi Noguchi
Toru Funayama
Masao Koda
Masashi Yamazaki
Publication date: 01-12-2018
Publisher: Springer London
Published in: Archives of Osteoporosis / Issue 1/2018
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-018-0547-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Initial hospitalization with rigorous bed rest followed by bracing and rehabilitation as an option of conservative treatment for osteoporotic vertebral fractures in elderly patients: a pilot one arm safety and feasibility study

Abstract

Summary

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

New FRAX-based intervention and assessment thresholds for the Ecuadorian population

Association between metabolic syndrome and osteoporosis in Taiwanese middle-aged and elderly participants

Osteoporosis in postmenopausal women in this decade: a bibliometric assessment of current research and future hotspots

Patient satisfaction and efficacy of switching from weekly bisphosphonates to monthly minodronate for treatment and prevention of glucocorticoid-induced osteoporosis in Japanese patients with systemic rheumatic diseases: a randomized, clinical trial

Dysmobility syndrome is associated with prevalent morphometric vertebral fracture in older adults: the Korean Urban-Rural Elderly (KURE) study

Serum 25-hydroxyvitamin D status, quantitative ultrasound parameters, and their determinants in Greek population