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      We thank Dr. Rocha-Romero for his thoughtful comments on our paper relating to the diagnosis and management of vertebral compression fractures.
      • Alsoof D
      • Anderson G
      • McDonald CL
      • Basques B
      • Kuris E
      • Daniels AH
      Diagnosis and management of vertebral compression fracture [online ahead of print].
      We agree that the decision to refer for surgical management is multifaceted, especially when considering pain management. However, as you note, there is strong evidence supporting cement augmentation procedures. A systematic review of randomized controlled trials demonstrated that surgical treatment results in greater improvements in pain scores when compared with nonoperative treatment. Despite heterogeneity in many studies and limited inclusion to studies of osteoporotic vertebral compression fractures, it indicates that vertebroplasty and kyphoplasty are justified if pain is not alleviated using conservative measures.
      • Halvachizadeh S
      • Stalder AL
      • Bellut D
      • et al.
      Systematic review and meta-analysis of 3 treatment arms for vertebral compression fractures: a comparison of improvement in pain, adjacent-level fractures, and quality of life between vertebroplasty, kyphoplasty, and nonoperative management.
      The use of radiofrequency ablation of the medial branch nerves is an interesting and novel approach to pain management of vertebral compression fractures.
      • Solberg J
      • Copenhaver D
      • Fishman SM
      Medial branch nerve block and ablation as a novel approach to pain related to vertebral compression fracture.
      It targets the posterior spinal elements, which are thought to contribute considerably to pain. Randomized controlled trials are needed to validate how this approach compares with cement augmentation procedures and facet blocking procedure, which use prednisolone and lidocaine.
      • Wang B
      • Guo H
      • Yuan L
      • Huang D
      • Zhang H
      • Hao D
      A prospective randomized controlled study comparing the pain relief in patients with osteoporotic vertebral compression fractures with the use of vertebroplasty or facet blocking.
      Whether surgical or conservative management, it is critical to consent the patient for complications and ensure follow-up of care. Patients undergoing conservative management should be weary of prolonged immobilization, which leads to muscle strength loss and increases risk of medical complications.

      Shah S, Goregaonkar AB. Conservative management of osteoporotic vertebral fractures: a prospective study of thirty patients. Cureus. 8(3):e542.

      Furthermore, non-steroidal anti-inflammatory drugs may have adverse gastrointestinal effects. Patients undergoing surgical management should be informed of standard operative risks, such as infection and blood loss, in addition to cement leak and embolization, although these are rare. Techniques to minimize risk of these catastrophic complications include a transpedicular route in the lumbar spine, or costovertebral junction in the thoracic spine, and defining optimal cement viscosity prior to injection.
      • Heran MKS
      • Legiehn GM
      • Munk PL
      Current concepts and techniques in percutaneous vertebroplasty.
      We recommend that all patients with a vertebral compression fracture are followed up with a bone health assessment and that radiographs are obtained, if symptomatic, to monitor for new fractures.

      References

        • Alsoof D
        • Anderson G
        • McDonald CL
        • Basques B
        • Kuris E
        • Daniels AH
        Diagnosis and management of vertebral compression fracture [online ahead of print].
        Am J Med. 2022; (Published online March 18S0002-9343(22)00192-9)https://doi.org/10.1016/j.amjmed.2022.02.035
        • Halvachizadeh S
        • Stalder AL
        • Bellut D
        • et al.
        Systematic review and meta-analysis of 3 treatment arms for vertebral compression fractures: a comparison of improvement in pain, adjacent-level fractures, and quality of life between vertebroplasty, kyphoplasty, and nonoperative management.
        JBJS Rev. 2021; 9: e21.00045
        • Solberg J
        • Copenhaver D
        • Fishman SM
        Medial branch nerve block and ablation as a novel approach to pain related to vertebral compression fracture.
        Curr Opin Anaesthesiol. 2016; 29: 596-599
        • Wang B
        • Guo H
        • Yuan L
        • Huang D
        • Zhang H
        • Hao D
        A prospective randomized controlled study comparing the pain relief in patients with osteoporotic vertebral compression fractures with the use of vertebroplasty or facet blocking.
        Eur Spine J. 2016; 25: 3486-3494
      1. Shah S, Goregaonkar AB. Conservative management of osteoporotic vertebral fractures: a prospective study of thirty patients. Cureus. 8(3):e542.

        • Heran MKS
        • Legiehn GM
        • Munk PL
        Current concepts and techniques in percutaneous vertebroplasty.
        Orthop Clin North Am. 2006; 37: 409-434