Korean J Neurotrauma.  2017 Oct;13(2):130-136. 10.13004/kjnt.2017.13.2.130.

The Efficacy of Fentanyl Transdermal Patch as the First-Line Medicine for the Conservative Treatment of Osteoporotic Compression Fracture

• Choi JH
• Kang HD
• Park JH
• Gu BS
• Jung SK
• Oh SH

• KMID: 2394547
• DOI: http://doi.org/10.13004/kjnt.2017.13.2.130

Abstract

OBJECTIVE
There are no strong guidelines on how long or how we should undertake conservative treatment during the acute period of an osteoporotic vertebral compression fracture (VCF).
METHODS
We treated 202 patients with conservative treatment on VCF from March 2012 to August 2015. On inclusion criteria, 75 patients (22 males and 53 females) were included in the final analysis. After admission, a transdermal fentanyl patch with low dose (12.5 µg) application was attempted in all patients. In an unresponsive patient, the fentanyl patch was increased by 25 µg. After identifying the tolerable toilet ambulation of the patient without any assistance, hospital discharge was recommended. We classified two patient groups into one favorable group and one unfavorable group and compared several clinical and radiological factors.
RESULTS
Among 75 patients, the clinical outcome of 57 patients (76%) was favorable, but that of 18 patients (24%) was unfavorable. In clinical outcomes, the numeric rating scale at 6 and 12 months and Odom's criteria at 12 months was significantly different between the favorable and the unfavorable groups. The dose of the patches used showed statistically significant differences between the two groups (p=0.001).
CONCLUSION
The only statistically significant affecting factor for an unfavorable outcome was the use of a higher dose fentanyl patch. Our data inferred that the unresponsiveness to a low-dose fentanyl patch could be helpful to select patients necessary for percutaneous vertebroplasty or kyphoplasty.

Keyword

Ambulation; Fentanyl patch; Conservative treatment; Compression fracture; Osteoporotic compression fracture; Vertebroplasty

MeSH Terms

Fentanyl*
Fractures, Compression*
Humans
Kyphoplasty
Male
Transdermal Patch*
Vertebroplasty
Walking
Fentanyl

Figure

• 

  FIGURE 1 The flow diagram shows the conservative treatment protocol. VCF: vertebral compression fracture, MRI: magnetic resonance imaging, PRN: pro re nata, NRS: numeric rating scale.

• 

  FIGURE 2 The compression rate is calculated as: (b−a)/b×100, wherein “a” represents the anterior vertebral height and “b” represents the posterior vertebral height. The Cobb angle is measured as a “c.”

• 

  FIGURE 3 (A) Mean compression rate change. (B) Mean Cobb angle change.

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