Objective: Percutaneous vertebroplasty (PVP) is a widely used minimally invasive procedure for the treatment of osteoporotic vertebral compression fracture (OVCF), yet accelerating postoperative recovery and reducing complications remain critical clinical challenges that require urgent resolution. This study aimed to evaluate the clinical effectiveness of an optimized perioperative management strategy based on the Enhanced Recovery After Surgery (ERAS) concept in patients undergoing PVP.
Methods: From May 2022 to April 2024, a total of 301 patients with OVCF who underwent PVP were retrospectively enrolled in the retrospective cohort study. Using May 2023 as the implementation time point for the optimized perioperative management strategy in our department, all subjects were divided into the traditional group (155 cases) and the optimized strategy (ERAS) group (146 cases). The two groups were analyzed for visual analog scale (VAS) scores for low back pain at various time points before and after surgery, Oswestry Disability Index (ODI) at preoperative and 3 months postoperatively, postoperative first ambulation time, total length of hospital stay (LOS), postoperative LOS, postoperative rehydration volume, and postoperative complications. Group comparisons of continuous variables were performed using independent samples t-tests or Mann–Whitney U tests, while categorical variables were compared using χ2 tests or Fisher's exact tests. p-value < 0.05 was considered statistically significant.
Results: Compared to the traditional group, patients in the ERAS group exhibited significantly lower VAS pain scores at 2 and 4 h postoperatively, earlier postoperative first ambulation time, shorter total and postoperative LOS, and reduced postoperative intravenous rehydration volume (p < 0.05). However, no statistically significant differences were observed between the two groups in preoperative VAS scores, VAS scores at 24 h postoperatively and on the day of discharge, as well as in ODI scores both preoperatively and at 3 months postoperatively (p > 0.05). Additionally, the complication rates were similar between the two groups (p > 0.05).
Conclusion: For patients with OVCF, performing PVP under the optimized perioperative management strategy facilitates early pain relief, reduces the average LOS, shortens the postoperative first ambulation time, and significantly improves perioperative clinical outcomes.
| [1] |
C. Dai, G. Liang, Y. Zhang, Y. Dong, and X. Zhou, “Risk Factors of Vertebral Re-Fracture After PVP or PKP for Osteoporotic Vertebral Compression Fractures, Especially in Eastern Asia: A Systematic Review and Meta-Analysis,” Journal of Orthopaedic Surgery and Research 17 (2022): 161.
|
| [2] |
Y. Long, W. Yi, and D. Yang, “Advances in Vertebral Augmentation Systems for Osteoporotic Vertebral Compression Fractures,” Pain Research & Management 2020 (2020): 3947368.
|
| [3] |
Z. Zhang, Y. Zhang, L. Li, et al., “Risk Factors for Low Back Pain Following Percutaneous Vertebroplasty in Patients With Osteoporotic Vertebral Compression Fracture,” American Journal of Translational Research 16 (2024): 3778–3786.
|
| [4] |
D. Yu, Z. Liu, H. Wang, et al., “Treatment of Elderly Patients With Acute Symptomatic OVCF: A Study of Comparison of Conservative Treatment and Percutaneous Kyphoplasty,” Frontiers in Surgery 9 (2022): 942195.
|
| [5] |
F. Wang, R. Sun, S. D. Zhang, and X. T. Wu, “Comparison of Thoracolumbar Versus Non-Thoracolumbar Osteoporotic Vertebral Compression Fractures in Risk Factors, Vertebral Compression Degree and Pre-Hospital Back Pain,” Journal of Orthopaedic Surgery and Research 18 (2023): 643.
|
| [6] |
A. Haibier, A. Yusufu, H. Lin, et al., “Effect of Different Cement Distribution in Bilateral and Unilateral Percutaneous Vertebro Plasty on the Clinical Efficacy of Vertebral Compression Fractures,” BMC Musculoskeletal Disorders 24 (2023): 908.
|
| [7] |
J. McCarthy and A. Davis, “Diagnosis and Management of Vertebral Compression Fractures,” American Family Physician 94 (2016): 44–50.
|
| [8] |
H. Kehlet and D. W. Wilmore, “Multimodal Strategies to Improve Surgical Outcome,” American Journal of Surgery 183 (2002): 630–641.
|
| [9] |
J. Smith, S. Probst, C. Calandra, et al., “Enhanced Recovery After Surgery (ERAS) Program for Lumbar Spine Fusion,” Perioperative Medicine 8 (2019): 4.
|
| [10] |
C. Feng, Y. Zhang, F. Chong, et al., “Establishment and Implementation of an Enhanced Recovery After Surgery (ERAS) Pathway Tailored for Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery,” World Neurosurgery 129 (2019): e317–e323.
|
| [11] |
Development of an Enhanced Recovery After Surgery (ERAS) Approach for Lumbar Spinal Fusion,” Journal of Neurosurgery. Spine 26 (2017): 411–418.
|
| [12] |
F. Y. Kutsal and G. O. Ergin Ergani, “Vertebral Compression Fractures: Still an Unpredictable Aspect of Osteoporosis,” Turkish Journal of Medical Sciences 51 (2021): 393–399.
|
| [13] |
Z. W. Ji, C. Y. Fan, Z. L. Yu, X. X. Wu, and H. Q. Mao, “Enhanced Recovery After Surgery (ERAS) Relieves Psychological Stress in Patients With Osteoporotic Vertebral Compression Fracture Undergoing Percutaneous Kyphoplasty: An Observational Retrospective Cohort Study,” Journal of Orthopaedic Surgery and Research 18 (2023): 218.
|
| [14] |
R. Liang, H. Zhang, L. Xie, A. Sun, J. Wang, and J. Chen, “Application of Medical-Nurse Integration Health Education in Aged Patients Undergoing Percutaneous Vertebroplasty,” Medicine 102 (2023): e33879.
|
| [15] |
H. Johansson, K. Siggeirsdóttir, N. C. Harvey, et al., “Imminent Risk of Fracture After Fracture,” Osteoporosis International 28 (2017): 775–780.
|
| [16] |
C. Zhang, Y. Li, G. Wang, and J. Sun, “Fracture Severity Dependence of Bone and Muscle Performance in Patients Following Single or Multiple Vertebral Fractures,” Frontiers in Endocrinology 15 (2024): 1423650.
|
| [17] |
R. M. Y. Wong, P. Y. Wong, C. Liu, et al., “The Imminent Risk of a Fracture-Existing Worldwide Data: A Systematic Review and Meta-Analysis,” Osteoporosis International 33 (2022): 2453–2466.
|
| [18] |
V. B. Chakravarthy, H. Yokoi, D. J. Coughlin, M. R. Manlapaz, and A. A. Krishnaney, “Development and Implementation of a Comprehensive Spine Surgery Enhanced Recovery After Surgery Protocol: The Cleveland Clinic Experience,” Neurosurgical Focus 46 (2019): E11.
|
| [19] |
C. O. Stiller and P. Hjemdahl, “Lessons From 20 Years With COX-2 Inhibitors: Importance of Dose–Response Considerations and Fair Play in Comparative Trials,” Journal of Internal Medicine 292 (2022): 557–574.
|
| [20] |
L. Laurian, Z. Oberman, E. Graf, S. Gilad, E. Hoerer, and R. Simantov, “Calcitonin Induced Increase in ACTH, Beta-Endorphin and Cortisol Secretion,” Hormone and Metabolic Research 18 (1986): 268–271.
|
| [21] |
J. A. Knopp-Sihota, C. V. Newburn-Cook, J. Homik, G. G. Cummings, and D. Voaklander, “Calcitonin for Treating Acute and Chronic Pain of Recent and Remote Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis,” Osteoporosis International 23 (2012): 17–38.
|
| [22] |
E. Boucher, B. Rosgen, and E. Lang, “Efficacy of Calcitonin for Treating Acute Pain Associated With Osteoporotic Vertebral Compression Fracture: An Updated Systematic Review,” CJEM 22 (2020): 359–367.
|
| [23] |
C. Y. Fan, X. X. Wu, Z. W. Ji, L. L. Zhang, F. Zhou, and H. Q. Mao, “Application of Enhanced Recovery After Surgery in Patients With Osteoporotic Vertebral Compression Fractures Undergoing Percutaneous Kyphoplasty,” World Neurosurgery 181 (2024): e339–e345.
|
| [24] |
J. Hausel, J. Nygren, M. Lagerkranser, et al., “A Carbohydrate-Rich Drink Reduces Preoperative Discomfort in Elective Surgery Patients,” Anesthesia and Analgesia 93 (2001): 1344–1350.
|
| [25] |
Y. Cheng, X. Wu, J. Shi, and H. Jiang, “Percutaneous Vertebroplasty and Facet Blocking for Treating Back Pain Caused by Osteoporotic Vertebral Compression Fracture,” Pain Research & Management 2020 (2020): 5825317.
|
| [26] |
H. M. Zakaria, M. Bazydlo, L. Schultz, et al., “Ambulation on Postoperative Day #0 Is Associated With Decreased Morbidity and Adverse Events After Elective Lumbar Spine Surgery: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC),” Neurosurgery 87 (2020): 320–328.
|
| [27] |
A. Bergland, H. Thorsen, and R. Kåresen, “Effect of Exercise on Mobility, Balance, and Health-Related Quality of Life in Osteoporotic Women With a History of Vertebral Fracture: A Randomized, Controlled Trial,” Osteoporosis International 22 (2011): 1863–1871.
|
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2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
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