Inpatient spinal intervention is associated with improved outcomes following thoracolumbar pathologic compression fractures: a national retrospective study

Abstract

Background: Pathologic vertebral compression fractures (pVCFs) are associated with significant pain and worsened quality of life. Spinal interventions such as kyphoplasty, vertebroplasty, and radiofrequency ablation can improve patient outcomes; however, there is a paucity of data on the optimal timing of these procedures. This study aims to evaluate the real-world effectiveness of inpatient spinal interventions versus conservative management (CM) for pVCF patients. Methods: This is a retrospective cohort analysis of the Nationwide Readmissions Database from 2016 to 2022. Adult patients admitted non-electively for pathologic thoracolumbar wedge compression fractures were included. The primary outcome was hospital discharge to home. Outcomes for patients who underwent spinal intervention (kyphoplasty, vertebroplasty, and/or radiofrequency ablation) versus CM were compared using Poisson or logistic regression analyses. Results: 2933 patients were included (median age 77 years, 54.1% female) of whom 921 (31.4%) underwent spinal intervention. Compared with CM, those who underwent intervention were significantly more likely to be discharged home (61.1% vs 52.5%; adjusted OR 1.50, 95% CI 1.11 to 2.03, P=0.009), had significantly longer lengths of hospital stay (median 6 vs 4 days; Poisson rate ratio 1.61, 95% CI 1.12 to 2.10, P<0.001), and higher hospitalization cost (adjusted B 10.7, 95% CI 9.5 to 12.0, P<0.001). Among those discharged home during the index admission, there was no difference in 180-day major morbidity or mortality between groups. Conclusion: For pVCF patients, early inpatient spinal intervention was significantly associated with higher odds of discharge to home without increased adverse events.