Timing matters: Influence of vertebral augmentation timing on pain relief, cement leakage, and fracture progression in thoracolumbar vertebral compression fractures

Abstract

Background and aim

There is no consensus regarding the best timing of vertebral augmentation (VA) procedures for the treatment of osteoporotic thoracolumbar fractures. This study aims to determine if early VA (performed during the first 2 weeks of evolution) show an advantage over delayed surgery in terms of efficacy and safety outcomes, and to evaluate the role of different modifiable therapeutic variables on the same outcomes.

Material and methods

Single-center retrospective study including all patients aged >50 years who underwent VA for thoracolumbar osteoporotic fracture from 2010 to 2023. Patients with two events in less than 3 months or incomplete follow-up were excluded. Pain relief, fracture progression and cement extravasation were assessed with regression analyses.

Results

One hundred fifty-four procedures were analyzed, with no significant difference in pain relief according to the timing of surgery. Early VA (1–14 days after symptoms onset) was associated with higher risk of fracture progression compared to intermediate (15–60 days; OR 15.2, p = 0.001) and delayed (>60 days; OR 16.2, p = 0.013) procedures; higher risk of cement leakage into the disc or vascular space (OR 3.2, p = 0.025); but lower risk of spinal canal cement leakage (OR 0.16, p = 0.027). No differences were observed between vertebroplasty and kyphoplasty.

Discussion

Early VA showed equivalent but earlier effect on pain relief and reduced risk of spinal canal leakage when compared with delayed procedures, despite a non-clinically significant increased risk of fracture progression and cement leakage into the disc or drainage vessels. Thus, it was identified as the most effective strategy for balancing analgesic efficacy and procedural safety.