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

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.