Risk Factors for Poor Recovery of the Capacity to Perform Activities of Daily Living (ADL) after Vertebroplasty

• Published in: Sekizui geka Vol. 34; no. 3; pp. 279 - 285
• Main Authors: Shibamoto, Kazunori, Ninomiya, Koshi
• Format: Journal Article
• Language: English; Japanese
• Published: The Japanese Society of Spinal Surgery 2020
• Subjects: ADL; osteoporotic vertebral body fracture; vertebroplasty
• ISSN: 0914-6024; 1880-9359
• DOI: 10.2531/spinalsurg.34.279

Introduction : Osteoporotic vertebral fractures are known to increase periods of inactivity due to pain. Prolonged bed rest diminishes the capacity to perform activities of daily living (ADL), and contributes to the development of further medical complications in older adults. If the ADL capacity does not recover, it is often difficult for patients to return to their previous level or even return to their former residence. Accordingly, vertebroplasty has been performed regularly, since the 1990s, to provide pain relief for osteoporotic vertebral fracture patients. Various reports have claimed that vertebroplasty achieves acceptable pain control and satisfactory recovery of the patients' quality of life and ADL capacity. However, we have encountered cases with poor recovery of the ADL capacity, despite achieving a pain-free status. We aimed to evaluate the factors associated with poor recovery of the capacity to perform ADL after vertebroplasty.  Methods : There were 483 consecutive patients with osteoporotic vertebral fractures who were admitted to our hospital between April 2016 and March 2019. Among these, 34 underwent percutaneous vertebroplasty with hydroxyapatite. The following parameters were compared between the patients who showed a good recovery of their ADL capacity and those who showed a poor recovery : age, presence of prevalent fracture, past medical history (stroke, diabetes mellitus, renal dysfunction, Parkinson's disease, and psychiatric disorders), medications (steroids, anti-dementia drugs, and psychotropic drugs), body mass index, period from the onset of symptoms to the surgery (less than two weeks or over two weeks), preoperative and postoperative verbal rating scale pain scores, and uncomplicated rehabilitation.  Results : The mean age of the 34 patients (male, n=9 ; female, n=25) was 80 years. Past medical history and medication use could not be statistically analyzed because of the small number of cases. There were no significant differences observed in the following parameters: presence of prevalent fracture, body mass index, period from onset to operation, and preoperative and postoperative verbal rating scales. Age>80 years (p=0.03) and complicated rehabilitation (p=0.002) were associated with a significantly poorer recovery of the capacity to perform ADL.