Percutaneous vertebroplasty for senior patients with varying grades of osteoporotic vertebral compression fracture

Abstract

Objective To investigate therapeutic effects of percutaneous vertebroplasty (PVP) in treatment of varying grades of osteoporotic vertebral compression fracture (OVCF). Methods From January 2004 to October 2010,208 senior OVCF patients were treated by PVP in our department.They were 72 men and 136 women,aged from 70 to 96 years (average,77.8).A total of 242 vertebral bodies were affected,including 134 thoracic and 108 lumbar ones.The fracture and its severity were evaluated according to Genant's semi-quantitative visual method,with OVCF grades Ⅰ, Ⅱ and Ⅲ respectively corresponding to a compression ratio of less than 25％,25％ to 50％ and greater than 50％.The patients were examined postoperation to analyze the ratio of vertebral compression,stability of vertebral body,pain relief and leakage of bone cement. Results All patients in this series were followed up from 6 to 84 months (average,30.5months).The mean cement volumes for thoracic and lumbar bodies were respectively 2.6 ± 0.6 mL and 4.8 ±0.4 mL.The preoperative vertebral compression rate and cobb angle in patients with OVCF grades Ⅱ and Ⅲ were significantly improved postoperation ( P ＜ 0.05) except in the patients with OVCF grade Ⅰ ( P ＞ 0.05).There was no significant difference in pain relief among patients with OVCF grades Ⅰ,Ⅱ and Ⅲ (x2 =0.955,P ＞0.05).The rates of cement leakage were 3.2％ (1/31),10.3％ (15/145) and 25.8％ (17/66) for OVCF grades Ⅰ,Ⅱ and Ⅲ,respectively,but the leakage did not cause clinical symptoms in all patients.The complication rates for OVCFgrades Ⅰ,Ⅱand Ⅲ were respectively 6.5％ (2/31),6.9％ (10/145) and 22.7％ (15/ 66). Conclusions In treatment of varying grades of OVCF,PVP may not make a difference in pain relief,but with increasing OVCF severity it will achieve poorer therapeutic outcomes regarding recovery of vertebral compression and Cobb angle.It is suggested that PVP must be performed for patients with early 0VCF to avoid further vertebral compression. Key words: Spine; Vertebroplasty; Osteoporosis; Fracture, compression