The role of vertebroplasty in steroid-induced vertebral osteoporotic fractures

Abstract

Abstract Background Data: Glucocorticoid-induced osteoporosis is a well-known significant health problem worldwide that causes morbidity and mortality. Glucocorticoid-induced vertebral compression fracture is one of the most common types of osteoporotic fractures associated with significant morbidities such as severe agonizing pain, limited mobility, and spinal deformity. Percutaneous vertebroplasty (PV) can be performed in the treatment of refractory back pain in these cases of osteoporotic vertebral fractures (OVFs) without significant complication when conservative treatment fails. Purpose: To evaluate the clinical and radiographic outcomes of thoracolumbar OVFs treated with PV in adult osteoporotic patients with long-term corticosteroid therapy. Study Design: Retrospective clinical case series. Patients and Methods: Twenty-eight patients with painful steroid-induced OVFs underwent vertebroplasty in 61 vertebral levels. Inclusion and exclusion criteria were applied. Preoperatively, all patients were subjected to intensive diagnostic workups, including history taking and clinical and radiological examinations, such as CT scan and MRI. The procedure was guided by C-arm and considered complete when the unfilled area was less than 25% of the vertebral body height in the lateral radiograph. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess pre- and postoperative back pain and functional status of our patients. Results: Seventeen patients (60.71%) were males and eleven patients (39.28%) were females. The mean age was 57 ± 5.04 (range, 49–68) years. The mean follow-up of the patients was 38.4 2± 11.16 (range, 24–60) months. Overall, 61 levels were reported including 10 patients (39%) with a single level and 18 patients (61%) with two levels or more as follows: two levels in eight patients, three levels in six patients, four levels in three patients, and one patient with five levels. The most common affected region was the thoracolumbar junction (T11, T12, and L1) in 38.69%. Back pain VAS decreased from 7.29 ± 1.04 before vertebroplasty to 3.25 ± 0.75 one week after vertebroplasty, 1.68 + −0.66 at 12 months postoperatively, and 3.11 ± 1.13 at final follow-up 24 months postoperatively (p < 0.00) Conclusion: This study suggests that fast and substantial pain relief and quality of life improvement could be achieved after percutaneous vertebroplasty in most patients of glucocorticoid induced osteoporotic vertebral fractures. These improvements could be maintained up to one year, however this effect decline with time due to the progressive nature of the underlying disease. (2020ESJ209) Abstract: Background Data: Glucocorticoids induced osteoporosis (G-OP) is a well-known significant health problem worldwide that causes morbidity and mortality. Glucocorticoids induced vertebral compression fracture (G-VCF) is one of the most common types of osteoporotic fractures that associated with significant morbidities as severe agonizing pain, limited mobility and spinal deformity. Percutaneous vertebroplasty (PV) can be performed in treatment of refractory back pain in cases of G-VFs without significant complication when the conservative treatment failed. Purpose: Clinical and radiographical evaluation of thoracolumbar osteoporotic vertebral fractures treated by percutaneous vertebroplasty in adult osteoporotic patients with long time of corticosteroid therapy. Study design: Retrospective clinical case series. Patients and methods: Twenty-eight patients with painful steroid induced VCFs underwent vertebroplasty in sixty-one vertebral levels. Inclusion and exclusion criteria were applied. Preoperatively, intensive diagnostic workups were performed in all patients including history, clinical, radiological examination, and CT scanning. Sometimes, MRI thoracolumbar spine had been done. The procedure was guided by the C-arm and considered complete when the unfilled area was less than 25% of the vertebral body height in the lateral radiograph. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess pre and postoperative back pain and functional status of our patients. Results: Seventeen patients (60.71%) were males and eleven patients (39.28%) were female. The Mean age was 57±5.04 (range: 49-68) years. Over-all 61 levels reported including 10 patients (39%) with single level and 18 patients (61%) with two levels or more as follows (two levels in eight patients, three levels in six patients, four levels in three patients and only one patient with five levels). Most common region affected was thoracolumbar junction (T11, T12, L1) in (38.69%). Back pain VAS decreased from 7.29 ± 1.04 before vertebroplasty to VAS 3.25±0.75 one week after vertebroplasty, 1.68 ± 0.66 at 12 months postoperative, and 3.11±1.13 at final follow up 24 months postoperative (P<0.001). ODI improved from 40.82±12.32 (14-66) preoperative to 16.68±3.19 (10-24) at 12 months postoperatively and to 20.92±4.66(10-30) at final follow 24 months postoperatively (P<0.000). Conclusion: This study suggest that fast and substantial pain relief and quality of life improvement could be achieved after percutaneous vertebroplasty (PV) and these improvements could be maintained up to one year in most patients. PV can be performed efficiently and effectively in patients of glucocorticoids OVFs for treatment of refractory back pain without significant complication. (2020ESJ209) Key words: Osteoporotic Vertebral Fractures (OVFs), Glucocorticoids, Vertebroplasty. Thoracolumbar spine.