Efficacy Of Percutaneous Vertebroplasty Research Articles

Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients

To assess the immediate efficacy of percutaneous vertebroplasty (PVP) in relief of pain and improving mobility of patients with vertebral compression fractures (VCF) secondary to osteoporosis, 205 cases (175 patients) underwent 250 percutaneous injections of polymethylmethacrylate (PMMA; unilateral, 247 levels; bilateral, 3 levels) into vertebrae under CT and fluoroscopic guidance for 34 months. Patients were prospectively asked to quantify their pain on a visual analog scale (VAS) before and a day after PVP. The interval to mobilization was recorded in those who were immobilized because of pain and/or bed-rest therapy (115 cases). PVP was technically successful in all patients, with three cases of minimal complications. The mean VAS score available for 196 cases was improved from 7.22+/-1.89 (range, 3-10) to 2.07+/-1.19 (range, 0-10) by PVP. Ninety-four of 115 immobilized cases (81.7%) were mobile by 24 h after PVP, and the mean value was 1.9+/-2.8 days. The incidence of recurrent and new fractures was 15.6% in 4-25 months (mean, 15.3 months). PVP is a safe and effective treatment for relieving the pain associated with osteoporotic VCF and strengthening the vertebrae, avoiding refractures. This therapy leads to early mobilization and avoidance of the dangers of conservative therapy of bed-rest.

Efficacy of Percutaneous Vertebroplasty in the Treatment of Intravertebral Pseudarthrosis Associated With Noninfected Avascular Necrosis of the Vertebral Body

A retrospective clinical study on the effect of percutaneous vertebroplasty (PVP) in the treatment of intravertebral pseudarthrosis caused by avascular necrosis of a vertebral body. To evaluate the efficacy of PVP in the treatment of spinal instability associated with avascular necrosis. Two radiologic features of avascular necrosis of a vertebral body are intravertebral vacuum phenomenon and fluid collection, combined with a collapsed vertebra. These can sometimes result in dynamic instability due to intravertebral pseudarthrosis. A treatment for this instability, associated with avascular necrosis, has not been established. Sixteen patients with instability, associated with avascular necrosis of a vertebral body, were treated by PVP. The indicators of the condition included spinal instability associated with avascular necrosis, which was diagnosed by a vacuum phenomenon or by fluid collection in the vertebral body as found from imaging studies. The instability of the vertebral body was confirmed from the dynamic lateral view in both flexion and extension. The anterior body height and kyphotic angle changes between pre- and post-treatment were measured on a lateral radiograph. Plain radiography was used during the follow-up period (8-14 months; mean, 11 months) to assess the vertebral column stability. The pain level of each patient was assessed, both before and after the procedure, using a visual analog scale (VAS), ranging from 0 to 10. Marked or complete pain relief was achieved in eight (50%) patients, and moderate pain relief in six (38%), with the immediate postoperative average pain score reduced from 9.0 to 4.3. The mean corrected angle and vertebral height between pre- and post-treatment were 8.5 degrees and 7.0 mm (P =0.001), respectively. There was no significant change in the kyphotic angle of the treated level during the follow-up period (P =0.711). Percutaneous vertebroplasty is a reasonable procedure for the treatment of spinal instability associated with avascular necrosis, but not that caused by an infection. PVP was found to be a minimally invasive and effective procedure that provides pain relief and stabilization of spinal instability associated with noninfected avascular necrosis of the vertebral body.

4:19 Clinical factors influencing the therapeutic results of percutaneous vertebroplasty in osteoporotic vertebral compression fractures

Purpose of study: A clinical study was conducted to find out possible clinical factors influencing long-term therapeutic results in osteoporotic vertebral compression fractures (VCFs) after percutaneous vertebroplasty (PVP) using pre-established protocols.Methods used: The authors analyzed various clinical factors affecting therapeutic results of PVP in 215 patients with 532 symptomatic osteoporotic VCFs, performed by a single operator (range of the age of fractures, 1 week to 3 years). The patients were interviewed by a third party to assess four different variables (relief of pain, change in activity, analgesic use, patient satisfaction) of treatment results. The relationship between 16 clinical factors and each different variable of the results were statistically analyzed (mean follow-up, 15 months).of findings: Pain relief was rated in 45 cases as good; in 86 cases, fair; in 72 cases, no change and in 13 cases, worse. The sooner the duration from fracture to PVP, the more severe back pain, positive bone scan, and the lower mean T score on BMD, the better pain relief. Change in activity was rated by 16 as good; by 29, fair; by 162, no change and by 7, worse. The longer the duration, the less severe back pain, negative bone scan, paravertebral leakage, the less improvement in activity. Twenty-eight rated the effect of analgesic use as good, 43 as fair, 128 as no change and 15 as worse. Women and patients with negative bone scans appeared to be less improved. With regard to patient satisfaction, 56 were very satisfied, 96 were somewhat satisfied, 39 were somewhat dissatisfied and 24 were very dissatisfied. The longer the duration, negative bone scan, the higher the mean T score and paravertebral leakage, the less patients were satisfied. There were no serious complications related to the surgical procedures.Relationship between findings and existing knowledge: PVP has been used successfully in the treatment of osteoporotic VCFs, and has become a popular management procedure. However, there are no reliable criteria for success of PVP in practice except for a few results from short-term follow-up in a small population of the patients. In our study, the efficacy of PVP was confirmed in osteoporotic VCFs, but PVP was rated lower in pain relief and satisfaction compared with the previous studies and not significant in terms of change in activity and analgesic use.Overall significance of findings: These disparities might be mainly caused by the wide range of fracture age. The favorable clinical factors appeared to be positive bone scan imaging, shorter age of fractures and severity of pain and osteoporosis. The unfavorable factors were female gender, negative bone scan, mild osteoporosis and leakage of methacrylate into the paravertebral space. Long-term therapeutic results of PVP management can be improved in terms of early return to usual activity, improvement in pain relief, analgesic use and patient satisfaction, especially in bedridden elderly patients presenting severe focal pain and severe osteoporosis. Revision of the pre-existing criteria for patient selection for PVP might be needed.Disclosures: Device or drug: polymethylmethacrylate. Status: approved.Conflict of interest: No conflicts.