The role of bone scintigraphy in treatment planning, and predicting pain relief after kyphoplasty

Karam, Maroun; Lavelle, William F.; Cheney, Robert

doi:10.1097/mnm.0b013e3282f30598

Cited by 27 publications

(11 citation statements)

References 19 publications

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“…The literature about outcome predictors for BKP is scarce and rather focuses on preoperative diagnostics and patient selection in a sense that cases with a bone edema detectable on MRI or scintigraphy were experiencing very good pain relief [15,16]. Investigations for VP are more numerous.…”

Section: Discussionmentioning

confidence: 99%

Cement Volume is the Most Important Modifiable Predictor for Pain Relief in BKP: Results from SWISSspine, a Nationwide Registry

Röder

Maestretti

2012

The Spine Journal

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Purpose The effectiveness of vertebral augmentation techniques is a currently highly debated issue. The biomechanical literature suggests that cement filling volumes may play an important role in the ''dosage'' of vertebral augmentation and its pain alleviating effect. Good clinical data about filling volumes are scarce and most patient series are small. Therefore, we investigated the predictors of pain alleviation after balloon kyphoplasty in the nationwide SWISSspine registry where cement volumes are also recorded. Methods All single-level vertebral fractures with no additional fracture stabilization and availability of at least one follow-up within 6 months after surgery were included. The following potential predictors were assessed in a multivariate logistic regression model with the group's average pain alleviation of 41 points on VAS as the desired outcome: patient age, patient sex, diagnosis, preoperative pain, level of fracture, type of fracture, age of fracture, segmental kyphotic deformity, cement volume, vertebral body filling volume, and cement extrusions. Results There were 194 female and 82 males with an average age of 70.4 and 65.3 years, respectively. Female patients were about twice as likely for achieving the average pain relief compared to males (p = 0.04). The preoperative pain level was the strongest predictor in that the likelihood for achieving an at least 41-point pain relief increased by about 8 % with each additional point of preoperative pain (p \ 0.001). A thoraco-lumbar fracture had a three times higher odds for the average pain relief compared with a lumbar fracture (p = 0.03). An A.3.1 fracture only had about a third of the probability for average pain relief compared with an A.1.1 fracture (p = 0.004). Cement volumes up to 4.5 ml only had an approximately 40 % chance for a minimum 41-point pain alleviation as compared with cement volumes of at least 4.5 ml (p = 0.007). In addition, the relationship between cement volume and pain alleviation followed a dose-dependent pattern.Conclusions Cement volume was revealed as a significant predictor for pain relief in BKP. Cement volume was the third most important influential covariate and the most important modifiable and operator dependent one. The clear dose-outcome relationship between cement filling volumes and pain relief additionally supports these findings. Cement volumes of [4.5 ml seem to be recommendable for achieving relevant pain alleviation. Patient sex and fracture type and location were further significant predictors and all these covariates should be recorded and reported in future studies about the pain alleviating effectiveness of vertebral augmentation procedures.

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Section: Discussionmentioning

confidence: 99%

Cement Volume is the Most Important Modifiable Predictor for Pain Relief in BKP: Results from SWISSspine, a Nationwide Registry

Röder

Maestretti

2012

The Spine Journal

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“…48 Kyphoplasty is most successful at restoring the height of the fractured vertebral body if it is performed within 3 months of the occurence of fracture or onset of pain. 22,23,43,49,50 Short-term results show that 85% to 100% of patients have good to moderate pain relief. 26, 48 Wardlaw et al found that kyphoplasty had improved functional recovery compared with nonsurgical treatment.…”

Section: Operative Managementmentioning

confidence: 99%

Evaluation and Management of Vertebral Compression Fractures

Alexandru¹,

So²

2012

TPJ

228

151

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“…Bone scans may not become positive at the fracture site until about 10 days after the initial injury, and if the bone scan is obtained too early in the process, a falsenegative result may occur. 303 …”

Section: Radiographic Evaluationmentioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

131

121

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Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.

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The role of bone scintigraphy in treatment planning, and predicting pain relief after kyphoplasty

Cited by 27 publications

References 19 publications

Cement Volume is the Most Important Modifiable Predictor for Pain Relief in BKP: Results from SWISSspine, a Nationwide Registry

Cement Volume is the Most Important Modifiable Predictor for Pain Relief in BKP: Results from SWISSspine, a Nationwide Registry

Evaluation and Management of Vertebral Compression Fractures

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

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