Pain response in the first trimester after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures with or without bone marrow edema

Abstract

Background and purpose: Presence of bone marrow edema (BME) in osteoporotic vertebral compression fractures (VCF) detected by MR imaging as selection criterion for percutaneous vertebroplasty (PV) is speculative. To clarify significance of BME in VCF, we assessed pain response after PV in patients with VCF with full BME versus patients with VCF with absent BME.

Methods: From a cohort of patients with painful VCF selected for PV, pain response in 14 patients with absent BME in VCF was prospectively compared with pain response in 31 patients with full BME in VCF. Pain was evaluated before PV and at 1 and 3 months after PV with visual analog scores and analgesics used. Back pain in general and at treated vertebral levels was assessed.

Results: Pain decrease after PV at treated levels was observed in 10 (71%) patients with absent BME in VCF at both follow-up periods and in 29 (94%) patients with full BME 1 month after PV and 30 (97%) at 3 months after PV. Differences between the groups were significant (P = .04 at 1 month; P = .01 at 3 months). Pain response was not affected by other patient or imaging characteristics. General back pain after PV was comparable in both groups after PV (P = .08 at 1 month; P = .4 at 3 months).

Conclusion: Pain decrease after PV in patients with VCF is more frequently observed when full BME is present. Because 71% of patients with VCF with absent BME responded favorably on pain, PV should not be withheld based on absence of BME alone.

Figures

Fig 1.

Lateral STIR and T1-weighted MR images of various osteoporotic vertebral compression fractures with absent, partial, and full bone marrow edema (BME) before percutaneous vertebroplasty (PV) and lateral radiographic images after PV.

Fig 2.

Osteoporotic vertebral compression fracture of L2 with absent bone marrow edema (BME) treated by percutaneous vertebroplasty (PV). Lateral STIR and T1-weighted MR images of the lumbar spine before and after PV. In the middle, lateral and anteroposterior radiographic images after PV.

Fig 3.

Osteoporotic vertebral compression fractures of L1 and L3 with partial bone marrow edema (BME) treated by percutaneous vertebroplasty (PV). Lateral STIR and T1-weighted MR images of the lumbar spine before and after PV. In the middle are lateral and anteroposterior radiographic images after PV.

Fig 4.

Osteoporotic vertebral compression fracture of L1 with full bone marrow edema (BME) treated by percutaneous vertebroplasty (PV). Lateral STIR and T1-weighted MR images of the lumbar spine before and after PV. In the middle, lateral and anteroposterior radiographic images after PV.

Fig 5.

Visual analog score (VAS) for pain both preprocedure (0 months) and at follow-up periods after percutaneous vertebroplasty (PV) in patients with absent bone marrow edema (no BME) in treated vertebral compression fractures and patients with full BME in treated VCF.

Fig 6.

Analgesic use both before percutaneous vertebroplasty (PV) (0 months) and at follow-up periods after PV in patients with absent bone marrow edema (no BME) in treated vertebral compression fractures (VCF) and patients with full BME in treated VCF. NSAID indicates nonsteroidal anti-inflammatory drug.