A prospective study of percutaneous vertebroplasty for chronic painful osteoporotic vertebral compression fracture

Hong-Yu Tan, Li-Min Wang, Liang Zhao, Yi-Lin Liu, Rui-Peng Song, Hong-Yu Tan, Li-Min Wang, Liang Zhao, Yi-Lin Liu, Rui-Peng Song

Abstract

Background: Percutaneous vertebroplasty (PVP) for patients with chronic painful osteoporotic compression fractures has not been extensively studied.

Objective: To prospectively evaluate the efficacy of PVP for patients with chronic painful osteoporotic vertebral compression fractures (VCFs).

Methods: Sixty-two consecutive patients with chronic painful osteoporotic VCFs for ≥3 months underwent PVP. All procedures were performed under local anesthesia. The outcomes were pain relief at one week, one month, three months, six months and one year, as measured by visual analogue scale, Oswestry Disability Index, Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) and Roland Morris Disability Questionnaire scores.

Results: The PVP procedures were technically successful and well tolerated in all patients. Sixty-two patients underwent PVP on 92 vertebrae in 73 procedures three to five days after referral, and no 30-day mortality was observed. Compared with baseline scores, improvement in visual analogue scale, Oswestry Disability Index, QUALEFFO and Roland Morris Disability Questionnaire scores was significantly greater after PVP at one week (P<0.001), one month (P<0.001), three months (P<0.001), six months (P<0.001) and one year (P<0.001), and the number of patients using drugs for pain treatment was significantly reduced. Five new fractures were reported in five of 62 patients treated with PVP during follow-up.

Conclusion: PVP is effective in patients with chronic painful osteoporotic VCFs. Pain relief after PVP was immediate, was sustained for one year and may be an important factor for reducing persistent pain.

Figures

Figure 1)
Figure 1)
A 74-year-old male patient with persistent back pain and a visual analogue scale score of 7 for >10 months. Coronary (A) and sagittal (B) computed tomography reconstruction demonstrates a border of osteosclerosis at the fracture site (arrow). Anteroposterior (C) and lateral (D) plain films show bone cement injected into the L1 and L2 vertebral bodies with slight vein leakage (arrow) at the L2 level. Magnetic resonance imaging reveals low signal (arrowhead) on T1WI images (E) and high signal (arrowhead) on T2WI (F) at the L1 level before percutaneous vertebroplasty. Note also a hemangioma (arrow) at the L2 level. Magnetic resonance imaging displays low signal (arrowhead) on T1WI (G) and slightly high signal (arrowhead) on T2WI (H) images at the L1 level one year after percutaneous vertebroplasty with stability of the vertebral body without obvious focal kyphosis

References

    1. Klazen CA, Lohle PN, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): An open-label randomised trial. Lancet. 2010;376:1085–92.
    1. Evans AJ, Jensen ME, Kip KE, et al. Vertebral compression fractures: Pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology. 2003;226:366–72.
    1. Hulme PA, Krebs J, Ferguson SJ, Berlemann U. Vertebroplasty and kyphoplasty: A systematic review of 69 clinical studies. Spine. 2006;31:1983–2001.
    1. Zoarski GH, Snow P, Olan WJ, et al. Percutaneous vertebroplasty for osteoporotic compression fractures: Quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol. 2002;13:139–48.
    1. McGraw JK, Lippert JA, Minkus KD, Rami PM, Davis TM, Budzik RF. Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: Results and follow-up. J Vasc Interv Radiol. 2002;13:883–6.
    1. Legroux-Gérot I, Lormeau C, Boutry N, Cotten A, Duquesnoy B, Cortet B. Long-term follow-up of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Clin Rheumatol. 2004;23:310–7.
    1. Voormolen MH, Lohle PN, Lampmann LE, et al. Prospective clinical follow-up after percutaneous vertebroplasty in patients with painful osteoporotic vertebral compression fractures. J Vasc Interv Radiol. 2006;17:1313–20.
    1. Anselmetti GC, Corrao G, Monica PD, et al. Pain relief following percutaneous vertebroplasty: Results of a series of 283 consecutive patients treated in a single institution. Cardiovasc Intervent Radiol. 2007;30:441–7.
    1. Alvarez L, Alcaraz M, Pérez-Higueras A, et al. Percutaneous vertebroplasty: Functional improvement in patients with osteoporotic compression fractures. Spine. 2006;31:1113–8.
    1. Ploeg WT, Veldhuizen AG, The B, Sietsma MS. Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: A systematic review. Eur Spine J. 2006;15:1749–58.
    1. 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. 2010;35:478–82.
    1. McGirt MJ, Parker SL, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL. Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: An evidenced-based review of the literature. Spine J. 2009;9:501–8.
    1. Brown DB, Glaiberman CB, Gilula LA, Shimony JS. Correlation between preprocedural MRI findings and clinical outcomes in the treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty. AJR Am J Roentgenol. 2005;184:1951–5.
    1. Brown DB, Gilula LA, Sehgal M, Shimony JS. Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty. AJR Am J Roentgenol. 2004;182:319–22.
    1. Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8:1137–48.
    1. Fairbank J, Pynsent P. The Oswestry Disability Index. Spine. 2000;25:2940–53.
    1. Lips P, Cooper C, Agnusdei D, et al. Quality of life in patients with vertebral fractures: Validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) Osteoporos Int. 1999;10:150–60.
    1. Roland M, Morris R. A study of the natural history of low-back pain. Part II: Development of guidelines for trials of treatment in primary care. Spine. 1983;8:145–50.
    1. Phillips FM. Minimally invasive treatments of osteoporotic vertebral compression fractures. Spine. 2003;28:S45–S53.
    1. Silverman SL. The clinical consequences of vertebral compression fracture. Bone. 1992;13:S27–S31.
    1. Shen WJ, Shen YS. Nonsurgical treatment of three-column thoracolumbar junction burst fractures without neurologic deficit. Spine. 1999;24:412–5.
    1. Eck JC, Nachtigall D, Humphreys SC, Hodges SD. Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: A meta-analysis of the literature. Spine J. 2008;8:488–97.
    1. Kaufmann TJ, Jensen ME, Schweickert PA, Marx WF, Kallmes DF. Age of fracture and clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2001;22:1860–3.
    1. Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361:557–68.
    1. Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361:569–79.

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