Symptomatic Vertebral Compression Fractures Research Articles

Percutaneous vertebroplasty in a series of myasthenic patients with steroid-induced symptomatic vertebral fractures

Vertebral compression fractures (VFs) are observed in 30-50 % of patients affected by steroid-induced osteoporosis, with consequentially severe back pain and functional limitation. An alternative treatment to medical therapy for pain caused by recent VFs is percutaneous vertebroplasty (PVP). Patients were treated by PVP after careful selection, based on the presence of persistent pain not resolved by standard medical therapy, correlation between pain and level of the VF, and neuroradiological features. We performed PVP in 4 patients with generalized MG associated with recent steroid-induced symptomatic VFs. Relief from pain was very rapid, usually within 24 h, and retained at a 3-month evaluation. No severe complication or MG worsening were observed in the post-operative period. Although clinical indication for PVP is still controversial, in our experience PVP is a useful and safe tool to be considered in the management of recent steroid-induced symptomatic VFs in selected MG patients.

Current concepts of percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures: Evidence-based review

Vertebral compression fractures constitute a major health care problem, not only because of their high incidence but also due to both direct and indirect consequences on health-related quality of life and health care expenditures. The mainstay of management for symptomatic vertebral compression fractures is targeted medical therapy, including analgesics, bed rest, external fixation, and rehabilitation. However, anti-inflammatory drugs and certain types of analgesics can be poorly tolerated by elderly patients, and surgical fixation often fails due to the poor quality of osteoporotic bone. Balloon kyphoplasty and vertebroplasty are two minimally invasive percutaneous surgical approaches that have recently been developed for the management of symptomatic vertebral compression fractures. The purpose of this study was to perform a comprehensive review of the literature and conduct a meta-analysis to compare clinical outcomes of pain relief and function, radiographic outcomes of the restoration of anterior vertebral height and kyphotic angles, and subsequent complications associated with these two techniques.

Magnetic Resonance Enhancement Patterns at the Different Ages of Symptomatic Osteoporotic Vertebral Compression Fractures

Magnetic Resonance Enhancement Patterns at the Different Ages of Symptomatic Osteoporotic Vertebral Compression Fractures

Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures

Cement augmentation is a controversial treatment for painful vertebral compression fractures (VCF). Our research questions for the meta-analysis were: Is there a clinical and statistical difference in pain relief, functional improvement, and quality of life between conservative care and cement augmentation for VCF and, if so, are they maintained at longer time points? We conducted a search of MEDLINE from January 1980 to July 2011 using PubMed, Cochrane Database of Systematic Reviews and Controlled Trials, CINAHL, and EMBASE. Searches were performed from medical subject headings. Terms "vertebroplasty" and "compression fracture" were used. The outcome variables of pain, functional measures, health-related quality of life (HRQOL), and new fracture risk were analyzed. A random effects model was chosen. Continuous variables were calculated using the standardized mean difference comparing improvement from baseline of the experimental group with the control group. New vertebral fracture risk was calculated using log odds ratio. Six studies met the criteria. The pain visual analog scale (VAS) mean difference was 0.73 (confidence interval [CI] 0.35, 1.10) for early (<12 weeks) and 0.58 (CI 0.19, 0.97) for late time points (6 to 12 months), favoring vertebroplasty (p < 0.001). The functional outcomes at early and late time points were statistically significant with 1.08 (CI 0.33, 1.82) and 1.16 (CI 0.14, 2.18), respectively. The HRQOL showed superior results of vertebroplasty compared with conservative care at early and late time points of 0.39 (CI 0.16, 0.62) and 0.33 (CI 0.16, 0.51), respectively. Secondary fractures were not statistically different between the groups, 0.065 (CI -0.57, 0.70). This meta-analysis showed greater pain relief, functional recovery, and health-related quality of life with cement augmentation compared with controls. Cement augmentation results were significant in the early (<12 weeks) and the late time points (6 to 12 months). This meta-analysis provides strong evidence in favor of cement augmentation in the treatment of symptomatic VCF fractures.

Percutaneous Vertebroplasty for Symptomatic Osteoporotic Vertebral Compression Fracture Adjacent to Lumbar Instrumented Circumferential Fusion

The purpose of this study was to evaluate the efficacy and safety of percutaneous vertebroplasty for patients with symptomatic osteoporotic vertebral compression fractures adjacent to lumbar instrumented circumferential fusion. Between January 2005 and June 2010, eighteen patients in the authors' institution with lumbar instrumented circumferential fusion had adjacent symptomatic osteoporotic vertebral compression fractures. The patients received percutaneous vertebroplasty using polymethylmethacrylate bone cement augmentation. Radiographs and magnetic resonance imaging were used. The visual analog pain scale and modified Brodsky's criteria were used to compare clinical outcomes pre- and postoperatively. Minimum follow-up was 18 months. Dual-energy x-ray absorptiometry scan confirmed osteoporosis in all patients. The average interval between fusion surgery and sustaining osteoporotic vertebral compression fractures was 24.8 months. The average interval between sustaining osteoporotic vertebral compression fractures and undergoing percutaneous vertebroplasty was 49.3 days. One-level percutaneous vertebroplasty was performed in 13 patients, and 2 levels were performed in 5 patients. The patients' visual analog pain scale scores improved by an average of 53 points postoperatively. Fifteen patients returned to preinjury activities of daily living. The average restoration of the fractured vertebral body height was 12.1%. No major surgery-related complications, occurred except asymptomatic cement leakage in 3 patients. Elderly patients undergoing lumbar instrumented fusion surgery should be aware of the possibility of adjacent vertebral compression fractures. Percutaneous vertebroplasty is a minimally invasive and effective procedure to treat such adjacent segment disease.

Hypovitaminosis D as a risk factor of subsequent vertebral fractures after kyphoplasty

Over the past 20 years, methods of minimally invasive surgery have been developed for the treatment of vertebral compression fractures. Balloon kyphoplasty and vertebroplasty are associated with a recurrent fracture risk in the adjacent levels after the surgical procedure. In certain patient categories with impaired bone metabolism, the risk of subsequent fractures after kyphoplasty is increased. To determine the incidence of recurrent fractures after kyphoplasty and explore whether the status of bone metabolism and 25-hydroxyvitamin D (25(OH)D) levels affect the occurrence of these fractures. Prospective longitudinal clinical study. Forty female postmenopausal women with primary osteoporosis and acute symptomatic vertebral compression fractures. Identification of new vertebral fractures and documentation of indicators of bone metabolism. A total of ninety-eight kyphoplasties were performed in 40 female patients. Balloon kyphoplasty was performed on all symptomatic acute vertebral compression fractures. Age, body mass index, history of tobacco use, number of initial vertebral fractures, intradiscal cement leakage, history of nonspinal fractures, use of antiosteoporotic medications, bone mineral density, bone turnover markers, and 25(OH)D levels were assessed. All participants were evaluated clinically and/or radiographically. Follow-up period was 18 months. The mean population age was 70.6 years (range, 40-83 years). After initial kyphoplasty procedure, nine patients (11 levels) (22.5% of patients; 11.2% of levels) developed a postkyphoplasty vertebral compression fracture. Cement leakage was identified in seven patients (17.5%). The patients without recurrent fractures after kyphoplasty demonstrated higher levels of 25(OH)D (22.6±5.51 vs. 14.39±7.47; p=.001) and lower N-terminal cross-linked telopeptide values (17.11±10.20 vs. 12.90±4.05; p=.067) compared with the patients with recurrent fractures. Bone metabolism and 25(OH)D levels seem to play a role in the occurrence of postkyphoplasty recurrent vertebral compression fractures.

Osteoporotic vertebral compression fracture augmentation by injectable partly resorbable ceramic bone substitute (Cerament™|SPINESUPPORT): a prospective nonrandomized study

This study aimed to evaluate long-term stabilizing healing effectiveness and influence on adjacent intact vertebral bodies of a new injectable partly resorbable calcium sulfate (60wt.%)/hydroxyapatite (40wt.%) bone substitute employed in vertebral augmentation of osteoporotic collapses. From April 2009 to April 2011, 80 patients underwent vertebral augmentation. Patient enrolment criteria are as follows: age more than 20years; symptomatic osteoporotic vertebral compression fracture from low energy trauma encompassing level T5 to L1 and classified as A1.1 to A1.2 according to the AO classification system; vertebral height compression within 0-75% compared to the posterior (dorsal) wall; client history confirming the age of the compression fracture to be within at least 4weeks; and patients who are able to understand the procedure and participate in the study. Preoperative and postoperative imaging studies consisted of computed tomography, plain X-ray, dual X-ray absorptiometry scanning, and magnetic resonance. Pain intensity has been evaluated by an 11-point visual analog scale (VAS), and physical and quality of life compromise assessments have been evaluated by Oswestry Disability Questionnaire (ODI). All procedures have been performed fluoroscopically guided by left unilateral approach under local anesthesia and mild sedation. VAS-based pain trend over 12-month follow-up has shown a statistical significant (p < 0.001) decrease, starting from 7.68 (SD 1.83) preoperatively with an immediate first day decrease at 3.51 (SD 2.16) and 0.96 (SD 0.93) at 12months. The ODI score dropped significantly from 54.78% to 20.12% at 6months. None device-related complication has been reported. In no case, a new incidental adjacent fracture has been reported. Data show how this injectable partly resorbable ceramic cement could be a nontoxic and lower stiffness alternative to polymethylmethacrylate for immediate and long-term stabilization of osteoporotic collapsed vertebral bodies.

Our percutaneous vertebroplasty applications in vertebral compression fratures

We aimed to investigate the effectiveness and complications of the percutaneous vertebroplasty (PVP) applications in vertebral compression fractures. Our study was carried out as a retrospective study in which PVP was conducted on patients with vertebral compression fractures due to benign or malignant causes between October 2006 and December 2009. The patients' pain was evaluated on a visual analog scale (VAS). In addition, the amount of cement injected, whether or not any leakage from the vertebrae corpus was seen, and any complications resulting from the application during or after the operation were recorded. The age and gender of the patients, duration of pain, number and location of fractured vertebrae, and the duration of follow-up were also collected for evaluation. A total of 15 patients were included in the assessment. Of the patients, 13 were female, and the mean age was 69.5±8.5 years. A total of 19 PVPs were applied to the 15 patients. While initial VAS scores were 7.9±1.6, at the end of an average of 10.3±3.8 (range: 4-18) months of follow-up, VAS scores had fallen to 2.6±2.7. 80% of the patients reported at least a 50% reduction in pain scores compared to initial scores, and 86.7% of them reported at least a 2-point decrease in VAS scores. In three patients, leakage of cement into the intervertebral disc occurred. PVP may be used successfully in symptomatic vertebral compression fractures not responding to medical treatment, with a low rate of complications.

Radiofrequency-targeted vertebral augmentation versus traditional balloon kyphoplasty: radiographic and morphologic outcomes of an ex vivo biomechanical pilot study

PurposeTraditional balloon kyphoplasty (BK) is a common treatment for symptomatic vertebral compression fractures. The purpose of this study was to compare a novel vertebral augmentation technique, radiofrequency-targeted vertebral augmentation (RF-TVA), to BK for restoration of vertebral height, cavity creation, and polymethylmethacrylate (PMMA) delivery and interdigitation into the surrounding trabeculae.MethodsThis ex vivo biomechanical pilot study utilized 16 osteoporotic cadaveric vertebral bodies in a standardized fracture model to compare unipedicular RF-TVA (n = 8) to bipedicular BK (n = 8). Four specimens from each group were tested in loaded and unloaded conditions. All specimens were imaged, assessed for height restoration, and sectioned to observe PMMA distribution. A subset of specimens underwent computed tomography scanning to assess cavity creation and trabecular architecture prior to cement delivery.ResultsAnterior height restoration was greater with RF-TVA (median: 84%, interquartile range: 62%–95%) compared to BK (median: 69%, interquartile range: 60%–81%), although the difference did not achieve statistical significance (P = 0.16). Anterior height restoration was numerically greater under loaded (median: 70% versus 66%) and unloaded (median: 94% versus 77%) conditions with RF-TVA versus BK. RF-TVA produced more discrete cavities and less native trabecular destruction compared to marked trabecular destruction observed with BK. RF-TVA consistently showed a well-identified focal area of PMMA with an extensive peripheral zone of PMMA interdigitation, providing mechanical interlock into the adjacent intact trabecular matrix. In contrast, BK yielded little evidence of PMMA interdigitation beyond the boundaries created by the balloon tamp due to the crushed trabecular bone peripherally.ConclusionRF-TVA achieves favorable vertebral height restoration with targeted PMMA delivery and less trabecular destruction compared to BK. RF-TVA has potential clinical utility in the aging population with painful osteoporotic vertebral fracture.

Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty

Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are effective procedures to alleviate pain caused by osteoporotic vertebral compression fractures (VCFs). New vertebral compression fracture (NVCF) has been noted as a potential late sequela of the procedures. The incidence of NVCFs and affecting risk factors were investigated. The authors retrospectively analyzed the occurrence of NVCFs in 147 patients treated with PVP or PKP for osteoporotic VCFs. Possible risk factors, such as age, gender, body mass index, bone mineral density (BMD), location of treated vertebra, treatment modality, amount of bone cement injected, anterior-posterior ratio of the fractured vertebra, cement leakage into the disc space, and pattern of cement distribution, were assessed. Twenty-seven patients (18.4%) had subsequent symptomatic NVCFs with a median time to new fracture was of 70 days. The 1-year symptomatic fracture-free rate was 85.0% by the Kaplan-Meier estimate. Eighteen (66.7%) of the 27 patients had an NVCF on the adjacent vertebra. Significant differences (P < 0.05) were found between the NVCF and control groups in regard to age, treatment modality, BMD, and the proportion of cement leakage into the disc space. Discal cement leakage and low BMD affected on adjacent NVCFs. The most important risk factors affecting NVCFs were osteoporosis and intervertebral discal cement leakage.

Unilateral Versus Bilateral Kyphoplasty for Osteoporotic Vertebral Compression Fractures

Study Design A retrospective study of patients who underwent kyphoplasty at a single institute. Objective To examine and compare the safety and long-term radiographic and clinical effects of unilateral or bilateral kyphoplasty to treat symptomatic vertebral compression fractures (VCF). Summary of Background Data Kyphoplasty (KP) involves placement of inflatable bone tamp via unilateral and bilateral approaches. Few randomized study comparing the radiographic and clinical outcomes using unilateral and bilateral approaches was reported. Methods 50 patients with osteoporotic vertebral compression fractures (VCF) were allocated into two groups adopting unilateral or bilateral kyphoplasty. Preoperative and postoperative pain scores, Vertebral body height were compared and analyzed. Results Both unilateral and bilateral kyphoplasty resulted in significant pain reduction. Significant increases of midline vertebral body height were recorded for both groups after surgery and maintained for the period of follow-up. Asymptomatic cement extravasation occurred in 8 of 50 patients, and 2 patients developed additional fractures at untreated levels during the period of follow-up. Conclusions Both unilateral and bilateral KP can improve clinical effects of osteoporotic VCF and result in significant vertebral height restoration for at least 18 months after treatment.

Vertebral augmentation treatment of painful osteoporotic compression fractures with the Kiva VCF Treatment System

Background Vertebral compression fractures (VCFs) can cause significant pain and functional impairment, and their cumulative effect can lead to progressive morbidity. This single-arm, prospective feasibility trial, conducted at 4 clinical sites, was undertaken to evaluate the clinical outcomes associated with the use of an innovative vertebral augmentation device, the Kiva VCF Treatment System (Benvenue Medical, Santa Clara, California), in the management of symptomatic VCFs associated with osteoporosis. Methods Vertebral augmentation treatment was performed for persistent back pain symptoms in 57 patients (mean age, 71.9 ± 10.4 years), including 46 women, with radiologically confirmed VCFs; 36 of these patients (63%) had reached 12 months of follow-up at this data analysis. There were 51 one-level cases, 5 two-level cases, and 1 three-level case, representing 64 treated levels. Back pain severity and condition-specific functional impairment were evaluated with a standard 100-mm visual analog scale and the Oswestry Disability Index (ODI), respectively, before device implantation as well as at 6 weeks, 3 months, and 12 months. Results Marked clinical improvements were realized in back pain severity and functional impairment through 12 months of follow-up. The mean back pain score on the visual analog scale improved from 79.3 ± 17.2 before treatment to 21.9 ± 21.3, 21.9 ± 24.6, and 23.2 ± 23.3 at 6 weeks, 3 months, and 12 months, respectively. The mean decrease at 12 months was 49.9 ± 30.3 mm, or approximately 66% ( P < .0001). Similarly, the mean ODI score improved from 68.1% ± 16.9% before treatment to 27.4% ± 17.2%, 23.8% ± 18.7%, and 23.3% ± 15.5% at 6 weeks, 3 months, and 12 months, respectively, representing a mean change of 39.2 ± 19.6 percentage points, or approximately 63%, at 12 months. Overall clinical success rates based on a 30% improvement in pain severity or greater and maintenance or improvement in the ODI were 91%, 88%, and 89% at 6 weeks, 3 months, and 12 months, respectively. The vertebral augmentation procedure required injection of a mean of 2.2 ± 0.12 mL of cement per vertebral body. There were 5 levels (8%) where cement extravasation was identified radiographically, and none were related to clinical symptoms. Conclusions These pilot findings are encouraging, suggesting robust and durable clinical improvement after this novel vertebral augmentation procedure in patients with painful VCFs.

Initial clinical experience with a novel vertebral augmentation system for treatment of symptomatic vertebral compression fractures: A case series of 26 consecutive patients

BackgroundMinimally invasive vertebral augmentation procedures are widely used to treat vertebral compression fractures although procedural polymethylmethacrylate cement leakage remains common. We report herein our initial experience with a novel vertebral augmentation technique designed to treat symptomatic vertebral osteoporotic fractures and osteolytic metastases with minimal cement extravasation.MethodsForty-two vertebral fractures were identified in 26 consecutive patients (mean age 74 ± 9 years). All patients were treated with a novel percutaneous vertebral augmentation device (Kiva® VCF Treatment System, Benvenue Medical, Santa Clara, CA, USA). Indications for surgery included recent (≤ 3 months) symptomatic osteoporotic vertebral fracture (n = 34) and pathologic vertebral fractures (e.g. metabolic bone disease, myeloma, metastasis) (n = 8) located between T10 and S1. Patient outcomes were evaluated pre-treatment and at 2- and 6-month follow-up visits. Postoperative cement extravasation was assessed with computed tomography. Patient-reported back pain was quantified using an 11-point numeric scale. Back-specific functional disability was self-reported with the Oswestry Disability Index on a 0 to 100% scale.ResultsNo cases of intraoperative hypotension, respiratory disturbance, neurological deterioration, infection, or death were observed. There were 2 (4.8%) levels where anterior cement leakage was visible radiographically in patients with osteolyses. No intracanal leakage was observed. Back pain scores improved 71% (p < 0.001) from pre-treatment to the 6-month follow-up. Back function improved 56% from baseline to 6 months (p < 0.001).ConclusionsThe initial clinical experience with the Kiva® System demonstrated significant improvements in back pain and function with minimal and clinically insignificant procedural cement leakage.

Role of vertebral augmentation procedures in the management of vertebral compression fractures in cancer patients

To review the current status of vertebral augmentation procedures (VAPs) in the management of symptomatic vertebral compression fractures (VCFs) in cancer patients. The natural history of VCFs in the cancer setting is presumably different from the one seen with osteoporotic fractures. Factors contributing to the poor outcome with conservative treatment in cancer patients include continued bone loss due to tumor invasion, poor nutritional status, immobilization, prolonged steroid use, gonadal ablation, chemotherapy and radiotherapy. VAPs have been shown by retrospective and prospective randomized studies to be effective in treating symptomatic VCFs. Advantages of VAPs include immediate pain relief, avoiding delays in chemoradiation, outpatient care in the majority of cases, biopsy, vertebral height restoration, and potential antitumor effect of bone cement. Results from the prospective randomized Cancer Fracture Evaluation (CAFÉ) trial show superiority of balloon kyphoplasty (BKP) over conservative management in cancer patients with VCFs with similar rate of adverse events between treatment arms. Additionally, the field is still evolving with advances such as combination with radiosurgery and spinal radiofrequency ablation (RFA), use of kyphoplasty without a balloon and highly viscous cement to prevent leakage. VAPs are well tolerated and effective methods to provide palliative care for cancer patients with VCFs and should be offered to symptomatic patients.

Clinical and radiographic evaluation of balloon kyphoplasty using VCFX for osteoporotic vertebral compression fracture

Abstract Objective In response to the major concerns of cement leakage and associated neurological injuries with regards to percutaneous vertebroplasty, balloon kyphoplasty (BK) was devised and introduced in 1998. This study retrospectively evaluated the clinical outcomes and radiological findings of the first 100 patients receiving BKs because of osteoporotic vertebral compression fractures (VCFs) at our institute. Materials and Methods A total of 100 patients (85 female and 15 male) with 130 osteoporotic VCFs undergoing BKs from January 2007 to July 2009 were enrolled. BK using VCFX (Central Medical Technologies, Taiwan) and associated polymethylmethacrylate augmentation was performed on these patients with symptomatic VCFs that responded poorly to conservative therapy. All patients received preoperative magnetic resonance imaging to determine which level needed BK. Radiographies were used for preoperative and postoperative imaging studies. A Huskisson’s visual analog scale was used to compare the clinical result of pain relief before and after surgery. Results The rupture of 20 (15.4%) balloons was noted during the operations. Nineteen (14.6%) cement leakages were found postoperatively, 7 cement leakages with balloon rupture and 12 with balloon integrity. No neurological complications occurred for either balloon rupture or integrity postoperatively. The visual analog scale scores improved from 87 preoperatively to 32 at final follow-up visit. Eighty-six patients returned to their preinjury activities of daily living and achieved better quality of life than their preoperative status. The average restoration of the fractured vertebral body height was 36.5%. The average correction of the sagittal alignment was 7.2°. Conclusions BK is an effective and low-risk method to treat painful osteoporotic VCFs. However, balloon rupture with Telebrex contrast medium extravasation is troublesome and can obscure the visual field of intraoperative fluoroscopy influencing the following injection of bone cement.

O-015 Cost-effectiveness of vertebroplasty and kyphoplasty vs non-surgical management for symptomatic vertebral compression fractures in the USA

Introduction and PurposeVertebroplasty (VP) and Kyphoplasty (KP) are minimally invasive surgical procedures which can relieve the pain of osteoporotic vertebral compression fractures (VCFs) and increase the functionality of patients, as...

Are persistently symptomatic vertebral compression fractures associated with abnormal inflammatory profiles? A prospective study. Golish SR, Hanna LS, Cuellar JM, et al. J Spinal Disord Tech 2011;24(2):121–5

Are persistently symptomatic vertebral compression fractures associated with abnormal inflammatory profiles? A prospective study. Golish SR, Hanna LS, Cuellar JM, et al. J Spinal Disord Tech 2011;24(2):121–5

Are Persistently Symptomatic Vertebral Compression Fractures Associated With Abnormal Inflammatory Profiles? A Prospective Study

A case-control study with prospectively collected samples for laboratory analysis in a series of patients with spinal fragility fractures and a series of patients without fracture who underwent fusion for LBP. Was an exploratory data analysis for candidate cytokine biomarkers present in the fracture milieu of patients with persistent back pain associated with vertebral compression fracture. Lumbar and thoracic compression fractures are common. Little is known about the presence of inflammatory mediators within fractured vertebra in the clinical setting. Thirty patients diagnosed with a single thoracic or lumbar compression fracture were treated with single level vertebroplasty. At the time of intervention, needle aspiration was carried out at the fractured level. A multiplexed bead assay was used to assess the presence of 27 different cytokines and inflammatory mediators. A control group consisted of needle aspiration samples of 30 lumbar vertebra from 13 patients with chronic pain but no fracture undergoing open instrumented fusion. Thirty patients with 30 fractures consisted of 23 female and 7 male with a mean age of 77.5 years (SD 13.6; range 42 to 97) and a mean of 3.9 weeks of pain (SD 3.1; range 1 to 12). The highest levels of inflammatory mediators were (in order): IL-1 receptor antagonist, PDGF, RANTES, IP-10, IL-8, and eotaxin. These mediators were present at concentrations>200 pg/mL. Compared with controls with chronic pain, significant differences were present for 4 mediators: TNF, MIP-1b, IL-9, and IL-12. The panel of these 4 markers was 93.3% specific and 66.7% sensitive for fracture compared with the control group. Inflammatory mediators are present in needle aspirates of symptomatic vertebral compression fractures. Some of these mediators show different levels than in patients with chronic pain but no fracture. Diagnostic level of evidence II.

Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures in the Nonagenarians

A prospective observational cohort study of consecutive osteoporotic vertebral compression fractures (VCFs) in ≥ 90-year-old patients evaluated at a multidisciplinary, university spine center. Assess efficacy, safety, and new fracture occurrence after percutaneous vertebroplasty (PV) in a large uncontrolled cohort of ultra elderly VCF patients. VCFs are associated with increased morbidity and mortality. Percutaneous injection of polymethylmethacryl-ate into the fractured vertebral body, vertebroplasty, has been extensively performed as an effective minimally-invasive treatment option for VCF patients. The patient sample included consecutive, osteoporotic patients with symptomatic VCFs electing to enter the study. Baseline visual analogue scale rating, analgesic usage, duration of symptoms. Subsequent VAS ratings, analgesic utilization, and new fractures were assessed within 30 minutes after the procedure, at 2 weeks, 1 month, 3 months, 6 months, 1 year, and 2 years postprocedure. Visual Analogue Scale score, analgesic utilization, patient satisfaction, cement extravasation, and new fractures. RESULTS.: A total of 123 (74% female) underwent PV for 163 VCFs. Eleven patients did not complete final follow-up at 2 years due to death unrelated to the PV procedure. The mean VAS score was 7.6 at baseline and 3.1 at 30 minutes after the procedure, and 2.3, 1.2, 1.1, 0.9, 0.8, and 0.5 at 2 weeks, 1 month, 3 months, 6 months, 1 year, and 2 years, respectively. Improvement over time was statistically significant using repeated measures analysis of variance (P < 0.05). No complications were encountered during the follow-up intervals. Thirteen new fractures were observed (10.6%) at a mean 20.8 weeks (1-52 weeks) after PV with 6 new fractures (4.9%) involving an adjacent level in 5 patients (4.1%). Vertebroplasty for VCFs in the very elderly appears effective and safe without increased risk of adjacent level fracture.

Comparing Clinical Outcomes Following Percutaneous Vertebroplasty with Conservative Therapy for Acute Osteoporotic Vertebral Compression Fractures

To compare the efficacy of percutaneous vertebroplasty (PV) with conservative therapy for patients with acute vertebral compression fractures. Prospective, nonrandomized, comparison study. The efficacy of PV has not been well established because there have been few comparative studies with conservatively treated control groups. Fifty-five consecutive patients (8 men and 47 women, age 47-94) with osteoporosis and symptomatic acute vertebral compression fractures were enrolled. thirty-two patients received pv, whereas 23 received conservative therapy. Changes in pain intensity, physical functioning, and pain medication requirement were evaluated. Both PV and conservative therapy provided pain reduction (P < 0.001), improvements in physical functioning (P < 0.001), and decreased medication (P < 0.001). Reductions in visual analogue pain scores were more significant in the vertebroplasty group at 1 (P < 0.001) and 4 weeks (P < 0.001) but not at 12 months. Improvements in physical functioning were significant at 1 (P < 0.001) and 4 weeks (P < 0.001). Medication requirements were lower in the vertebroplasty group at all three time points. Pain relief, physical functioning improvement, and medication requirement after vertebroplasty are immediately and significantly better when compared with conservative therapy.