Short term results of percutaneous vertebroplasty in patients with isolated traumatic vertebral compression fractures

Abstract

Objective — to analyze the effectiveness of percutaneous vertebroplasty (PV) in the short term postoperative period in patients with isolated traumatic vertebral compression fractures (IT VCF). The analysis of short term results of PV for IT VCF in patients (n=160) of two age groups: I — up to 60 years (n=106) and II — 60 years and older (n=54). The criteria for inclusion in the study were: high-energy spinal injury resulting a road accident or a high level fall; absence of signs of osteoporosis. The average pain intensity (M ± σ) before PV matched a severe pain (8.21±1.41 points according VAS in the general group). At 3 days after surgery, the pain radically decreased to insignificant (0.91±0.98 points), gradually decreased to 0.76±0.82 points during the first 3 months; there was a further tendency for its decreasing within the insignificant (up to 0.71±0.76 points after six months). At the same time, before the operation and during the nearest postoperative period, patients of group I had a somewhat lower intensity of pain than in group II. Dependence on painkillers observed in 100% of patients before surgery, in the first 3 days after PV 78.1% of all patients have lost it (80.2% — in group I, 74.0% — in group II); in 3 months — 95,6%, 96,2%, 94,5%, respectively; after 6 months — 96.2%, 97.2%, 94.5%, respectively. Motor activity before surgery was reduced in all patients (45.0% of them to the degree of bedbound). In 3 days after PVP, 60.6% of all patients returned to usual motor activity at home (65.1% in group I, 51.8% in group II), 93.7%, 3 months later, respectively, 2%, 87.0%; in 6 months — 96,3%, 99,1%, 90,7%. The persons of physical work who were employed at the time of injury, remained disabled 3 days after the PVP. Within 3 months, they all returned to work: to their usual work 83.7% in the former group, 90.7% in the first group and 52.9% in the second group; 16,3%, 9,3% and 47,1% of the patients, respectively, for work with facilitated conditions. After 6 months, the number of patients with full physical recovery in these groups reached 94.6%, 97.3% and 82.4%, respectively. Oswestry disability index (ODI), which before the operation was (57.7±20.1)% in the whole group, (55.7±20.85)% — in the first group and (59.6±18.54)% — in group II, and responded to severe disability, 3 days after surgery significantly (p<0.001) decreased and amounted to (31,2±15,89)%, (30,3±16,62)% and (31, 9±14,46)%, respectively, indicating moderate disability. After 3 months, ODI decreased to (18.8±17.45)% (p<0.05) in the general group and to (18.2±18.56)% and (19.1±15.18)% — in the relevant age groups, indicating a minimal disability. After 6 months, there was a tendency for further decrease of ODI (to (18.5±17.1)%) and (17.9±18.08)% and (19.0±15.24)%, respectively). So, in the short term after PV, the degree of disability of patients of both age groups decreased significantly. Thus, PV in patients with IT VCF provides rapid pain regression and improvement in the functional status of patients of both age groups — up to 60 years and 60 years and older. The most radical changes occur within the first 3 days after surgery. Further improvement of most options during the first 6 month is progressing gradually. The rates and completeness of the functional recovery are slightly higher in patients of the age group up to 60 years, compared with the group of 60 years and older.