Pain Relief by Percutaneous Vertebroplasty for Osteoporotic Compression Fractures: An Evaluation of Polymethylmethacrylate Injection Volume

Abstract

Percutaneous vertebroplasty may provide pain relief in the treatment of patients with severe osteoporotic compression fracture. A retrospective study was done to determine the relationship between injection volume and therapeutic benefits. Methods and Results: Polymethylmethacrylate (PMMA) was injected into 79 compression fractures in a total of 70 patients. The amounts of PMMA injected ranged from 2 to 9 milliliters. We divided our patients into two groups according to the volume of PMMA injected. Group A had the volume injected ranging from 2 to 5 milliliters whereas Group B, 6 to 9mL. The injection of bone cement was stopped immediately whenever a backflow opacification was observed in the posterior third of the vertebral body in order to prevent iatrogenic spinal cord compression. In Group A patients, the mean postoperative pain score was decreased to 1.28. The mean decreased pain score was 3.28. In Group B patients, the mean postoperative pain score decreased to 1.09. The mean decreased pain score was 3.39. There was no significant difference between these two groups in the decreased pain score (P=0.52) and postoperative pain status (P=0.14). Conclusions: The author found no correlation between the injection volume and its therapeutic benefit. Greater amount of PMMA injected will not give a better clinical outcome to patients with osteoporotic compression fracture. The injection of PMMA should be stopped immediately whenever a backflow opacification is observed in the posterior third of the vertebral body in order to prevent epidural leakage. The presence of PMMA epidural leakage may decrease the pain relief benefit after percutaneous vertebroplasty.