Impact Of the Covid-19 Pandemic on The Prevalence of Thoracolumbar Vertebral Compression Fractures in Elderly People: Covid-19 Pandemic on The Prevalence of Thoracolumbar Vertebral Compression Fractures

Amjad  Ali Qureshi; Muhammad  Mujahid Sharif; Badar Uddin  Ujjan; Musadique  Latif Memon; Saeed  ullah; Syed  Aamir Shah

doi:10.54393/pjhs.v3i04.90

Authors

Amjad Ali Qureshi Department of Neurosurgery and Gama Knife Radiosurgery, Pir Abdul Qadir Shah jillani (PAQSJ)institute Of Medical Science Gambat, Pakistan
Muhammad Mujahid Sharif Department of Neurosurgery, Pakistan Institute of Medical Sciences Islamabad, Pakistan
Badar Uddin Ujjan Department of Neurosurgery, Dow International Medical College and Dow University of Health Sciences Karachi, Pakistan
Musadique Latif Memon Department of Neurosurgery, Pakistan Institute of Medical Sciences Islamabad, Pakistan
Saeed ullah Department of Orthopeadic, ZKS Category C hospital Matta swat, Pakistan
Syed Aamir Shah Department of Neurosurgery, Pakistan Institute of Medical Sciences Islamabad, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v3i04.90

Keywords:

Spinal Fracture, Covid-19, Thoracic, Lumber, Impact

Abstract

Covid-19 had a profound effect on many parts of life during 2020. Our country, much like the majority of other nations across the globe, saw a Covid-19 epidemic, a wave reaching its height from the middle of March through April of 2020. This brought about significant difficulties for our civilization in a variety of spheres, including the medical, social, and economic spheres. On February 27th, the first patient in our country to be diagnosed with Covid-19 was identified. Objective: To evaluate the Covid-19 effect on the prevalence of thoracolumbar vertebral compression fractures in elderly people. Methods: A total of 172 individuals with vertebral compression fractures (VCF) were above the age of 65 years. The age and gender of the patients were comparable across the two research groups. Only those people who exhibited symptoms for less than four weeks were taken into account. We analyzed every patient's medical records and obtained all essential data, including demographics (gender, age, and compression fracture risk factors), fracture mechanism, and location of the fracture. Results: In 2020, we observed a greater percentage of high-energy VCF (10.5% versus 6.7%). In 2020, there were 7.5 times more recurrent fractures and the proportion of Ankylosing Spondylitis was much higher. Similar admission rates to VCF ED were observed, with 60% receiving conservative care. The number of procedures performed on admitted patients increased in 2020 (66.7% vs. 60%, P =.71), and PBK plus fixation tended to be more common in 2020 compared to 2018-19 (15.8% versus 7.5%, P =.29). In the Covid-19 epidemic, the RR for BKP Plus fixation vs. BKP alone was 1.95, indicating increased risks for difficult operation. In 2020, there were significantly more complications (18.4% vs 3.7%, P.001). Time to surgery also increased somewhat in 2020, from 6.25 days to 5.3 days (P =.55), and admission duration increased marginally (12.2 days vs. 9.9 days, P =.27). Most of the patients choose home treatment over inpatient care during the Covid-19 pandemic (72.2% vs. 58.8%). Conclusions: The frequency of VCF did not vary as a result of the Covid-19 pandemic; nevertheless, the features of patients did change, which had an effect on hospitalizations, institutional rehabilitative services, and a predilection for extensive surgery as opposed to BKP alone. Although it is not yet known whether or not COVID-19 will continue to be a problem in the years to come, the effects and lessons it has provided are still valuable.

References

Itelman E, Wasserstrum Y, Segev A, Avaky C, Negru L, Cohen D, et al. Clinical Characterization of 162 COVID-19 patients in Israel: Preliminary Report from a Large Tertiary Center. Israel Medical Association Journal. 2020 May; 22(5):271-274.

Liu J, Mi B, Hu L, Xiong Y, Xue H, Zhou W, et al. Preventive strategy for the clinical treatment of hip fractures in the elderly during the COVID-19 outbreak: Wuhan's experience. Aging (Albany NY). 2020 May; 12(9):7619-7625. doi: 10.18632/aging.103201.

Catellani F, Coscione A, D'Ambrosi R, Usai L, Roscitano C, Fiorentino G. Treatment of Proximal Femoral Fragility Fractures in Patients with COVID-19 During the SARS-CoV-2 Outbreak in Northern Italy. The Journal of bone and joint surgery. 2020 Jun; 102(12):e58. doi: 10.2106/JBJS.20.00617.

Thakrar A, Chui K, Kapoor A, Hambidge J. Thirty-Day Mortality Rate of Patients With Hip Fractures During the COVID-19 Pandemic: A Single Centre Prospective Study in the United Kingdom. Journal of Orthopaedic Trauma. 2020 Sep; 34(9):e325-e329. doi: 10.1097/BOT.0000000000001889.

Kayani B, Onochie E, Patil V, Begum F, Cuthbert R, Ferguson D, et al. The effects of COVID-19 on perioperative morbidity and mortality in patients with hip fractures. The Bone & Joint Journal. 2020 Sep;102-B(9):1136-1145. doi: 10.1302/0301-620X.102B9.BJJ-2020-1127.R1.

Park C, Sugand K, Nathwani D, Bhattacharya R, Sarraf KM. Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: the "golden month". Acta orthopaedica Scandinavica 2020 Oct; 91(5):556-561. doi: 10.1080/17453674.2020.1783621.

Maniscalco P, Poggiali E, Quattrini F, Ciatti C, Magnacavallo A, Vercelli A, et al. Proximal femur fractures in COVID-19 emergency: the experience of two Orthopedics and Traumatology Departments in the first eight weeks of the Italian epidemic. Acta Biomed Atenei Parmensis. 2020;91(2):89.

Lv H, Zhang Q, Yin Y, Zhu Y, Wang J, Hou Z, et al. Epidemiologic characteristics of traumatic fractures during the outbreak of coronavirus disease 2019 (COVID-19) in China: A retrospective & comparative multi-center study. Injury. 2020 Aug; 51(8):1698-1704. doi: 10.1016/j.injury.2020.06.022.

Hernigou J, Morel X, Callewier A, Bath O, Hernigou P. Staying home during "COVID-19" decreased fractures, but trauma did not quarantine in one hundred and twelve adults and twenty eight children and the "tsunami of recommendations" could not lockdown twelve elective operations. International orthopaedics. 2020 Aug; 44(8):1473-1480. doi: 10.1007/s00264-020-04619-5.

Luengo-Alonso G, Pérez-Tabernero FG, Tovar-Bazaga M, Arguello-Cuenca JM, Calvo E. Critical adjustments in a department of orthopaedics through the COVID-19 pandemic. International orthopaedics. 2020 Aug; 44(8):1557-1564. doi: 10.1007/s00264-020-04647-1.

Huang Z, Wan S, Ning L, Han S. Is unilateral kyphoplasty as effective and safe as bilateral kyphoplasties for osteoporotic vertebral compression fractures? A meta-analysis. Clinical Orthopaedics and Related Research. 2014 Sep; 472(9):2833-42. doi: 10.1007/s11999-014-3745-0.

Ensrud KE, Thompson DE, Cauley JA, Nevitt MC, Kado DM, Hochberg MC, et al. Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. Fracture Intervention Trial Research Group. Journal of the American Geriatrics Society. 2000 Mar; 48(3):241-9. doi: 10.1111/j.1532-5415.2000.tb02641.x.

Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Grunze M, et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporosis international. 1998; 8(3):261-7. doi: 10.1007/s001980050063.

Rostom S, Allali F, Bennani L, Abouqal R, Hajjaj-Hassouni N. The prevalence of vertebral fractures and health-related quality of life in postmenopausal women. Rheumatology international. 2012 Apr;32(4):971-80. doi: 10.1007/s00296-010-1734-5.

Agulnek AN, O'Leary KJ, Edwards BJ. Acute vertebral fracture. Journal of Hospital Medicine. 2009 Sep; 4(7):E20-4. doi: 10.1002/jhm.454.

Rousing R, Hansen KL, Andersen MO, Jespersen SM, Thomsen K, Lauritsen JM. Twelve-months follow-up in forty-nine patients with acute/semiacute osteoporotic vertebral fractures treated conservatively or with percutaneous vertebroplasty: a clinical randomized study. Spine (Phila Pa 1976). 2010 Mar; 35(5):478-82. doi: 10.1097/BRS.0b013e3181b71bd1.

Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. New England Journal of Medicine 2009 Aug; 361(6):569-79. doi: 10.1056/NEJMoa0900563.

Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. New England Journal of Medicine. 2009 Aug; 361(6):557-68. doi: 10.1056/NEJMoa0900429.

Frankel BM and Krishna V. Meta-analysis: vertebroplasty for vertebral compression fracture ineffective in improving pain and function. Journal of evidence based medicine and healthcare. 2012 Oct; 17(5):142-3. doi: 10.1136/ebmed-2011-100215.

Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, et al. Mortality after osteoporotic fractures. Osteoporos Int. 2004 Jan; 15(1):38-42. doi: 10.1007/s00198-003-1490-4.

Lau E, Ong K, Kurtz S, Schmier J, Edidin A. Mortality following the diagnosis of a vertebral compression fracture in the Medicare population. The Journal of bone and joint surgery. 2008 Jul; 90(7):1479-86. doi: 10.2106/JBJS.G.00675.

Ong KL, Beall DP, Frohbergh M, Lau E, Hirsch JA. Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty "sham" trials? Osteoporosis international. 2018 Feb; 29(2):375-383. doi: 10.1007/s00198-017-4281-z.

Goldstein CL, Chutkan NB, Choma TJ, Orr RD. Management of the Elderly With Vertebral Compression Fractures. Neurosurgery. 2015 Oct; 77 Suppl 4:S33-45. doi: 10.1227/NEU.0000000000000947.

Clark W, Bird P, Gonski P, Diamond TH, Smerdely P, McNeil HP, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2016 Oct; 388(10052):1408-1416. doi: 10.1016/S0140-6736(16)31341-1.

Wilson-Poe AR and Morón JA. The dynamic interaction between pain and opioid misuse. British journal of pharmacology 2018 Jul; 175(14):2770-2777. doi: 10.1111/bph.13873.

Chen AT, Cohen DB, Skolasky RL. Impact of nonoperative treatment, vertebroplasty, and kyphoplasty on survival and morbidity after vertebral compression fracture in the medicare population. The Journal of bone and joint surgery. 2013 Oct; 95(19):1729-36. doi: 10.2106/JBJS.K.01649.

McCullough BJ, Comstock BA, Deyo RA, Kreuter W, Jarvik JG. Major medical outcomes with spinal augmentation vs conservative therapy. JAMA Internal Medicine. 2013 Sep; 173(16):1514-21. doi: 10.1001/jamainternmed.2013.8725.

Prall JA, Davis JD, Jenkins NR. Editorial. Community practice in the time of COVID-19. Journal of neurosurgery 2020 Apr; 1-2. doi: 10.3171/2020.4.JNS201033.

Giorgi PD, Villa F, Gallazzi E, Debernardi A, Schirò GR, Crisà FM, et al. The management of emergency spinal surgery during the COVID-19 pandemic in Italy. Bone and Joint Journal. 2020 Jun; 102-B(6):671-676. doi: 10.1302/0301-620X.102B6.BJJ-2020-0537.

Tsuda T. Epidemiology of fragility fractures and fall prevention in the elderly: a systematic review of the literature. Current orthopaedic practice. 2017 Nov; 28(6):580-585. doi: 10.1097/BCO.0000000000000563.

Armitage R and Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health. 2020 May; 5(5):e256. doi: 10.1016/S2468-2667(20)30061-X.

Robinson Y, Tschöke SK, Stahel PF, Kayser R, Heyde CE. Complications and safety aspects of kyphoplasty for osteoporotic vertebral fractures: a prospective follow-up study in 102 consecutive patients. Patient Safety in Surgery. 2008 Jan; 2:2. doi: 10.1186/1754-9493-2-2.

Xiao H, Yang J, Feng X, Chen P, Li Y, Huang C, et al. Comparing complications of vertebroplasty and kyphoplasty for treating osteoporotic vertebral compression fractures: a meta-analysis of the randomized and non-randomized controlled studies. European Journal of Orthopaedic Surgery and Traumatology. 2015 Jul; 25 Suppl 1:S77-85. doi: 10.1007/s00590-014-1502-4.