DOS 2018

DOS Kongressen 2018 · 189 Short Clinical Guideline for the treatment of patients with painful low energy fractures of the spine with percutaneous vertebroplasty/ kyphoplasty Rousing Rikke, Østerheden Andersen Mikkel, Ernst Carsten ortopædkirurgisk afdeling, rygkirurgisk sektor, Odense Universitetshospital; rygkirurgisk afdeling, Middelfart sygehus; Rygkirurgisk afdeling, Silkeborg syge- hus Background: Percutaneous vertebroplasty (PVP) and ballon kyphoplasty (BK) has been used as treatment for painful low- energy fractures of the spine since the eighties. Several clinical studies have confirmed the pain-relieving effect of the procedures. But in 2009 two double-blinded RCT’s comparing PVP with sham claimed that the effect of PVP was not better than injection of local an- esthesia. Purpose / Aim of Study: To review the literature for systematic reviews and randomised studies comparing PVP/BK with conservative treatment/sham con- cerning parameters as pain, quality of life, physical performance, and complica- tions. Materials and Methods: Systematic review of the literature from 1980 until February 2018 based on the following PICO question “Should patients over the age of 50 years with painful low energy fractures of the spine be offered ver- tebral injection of bone cement in case of insufficient non- operative treatment for 2-8 weeks?” resulted in 16 systematic reviews, including up to 10 RCT’s, and two RCT’s not included in the reviews. All reviews were Amstar assessed re- sulting in exclusion of 4 reviews because of the lack of metaanalysis. The answer to the PICO question was assessed based on the GRADE system. Findings / Results: The metaanalysis show consistent and significant better outcome for PV/BK compared to conservative treatment concerning pain, qual- ity of life and physical performance. Only two of the randomized studies were double- blinded and the minimal clinical relevant improvement has not been reached in these studies. There is not increased risk of new vertebral fractures in patients treated with PVP/BK compared to conservative treated patients. Conclusions: Based on the above findings PVP/BK should be considered as treatment of patients with low energy fractures of the spine in case of insuf- ficient conservative treatment for 2-8 weeks 130.