The safety and efficacy of percutaneous vertebroplasty for patients over 90 years old

Noguchi

Interventional Radiology

et al. 2021

Self Cite

Bone cement enhancement by percutaneous vertebroplasty (PVP) for the treatment of osteoporotic vertebral compression fractures remains unapproved, as it has not been fully evaluated in Japan. The current multicenter study was conducted in Japan to verify the safety and efficacy of PVP in patients with painful osteoporotic vertebral fractures.Material and Methods: In this retrospective study, we referred to previous studies to evaluate the noninferiority of PVP to balloon kyphoplasty (BKP). We reviewed consecutive patient data from April 2017 to March 2018 from four institutions based on the medical records of the intervention. We statistically investigated the adverse events due to cement leakage or other factors associated with PVP, and new vertebral compression fractures after PVP were evaluated for safety, pain relief, and gait improvement.Results: This study included 485 patients; most of whom were in the middle-to oldest-age groups (mean age, 81.4 years). No serious adverse events were reported in patients available for safety evaluation (n = 485). Cement leakage and new vertebral compression fractures occurred in 35.7% and 18.6% (26.2%-38.4% and 8.9%-20.7%) of the patients undergoing PVP, respectively, both of which were also judged to be equivalent to those of BKP. The pain score improved in those undergoing PVP, and this improvement was maintained during a one-year follow-up. Of the 206 patients who had difficulty walking at baseline, 156 had restored walking at discharge.Conclusions: PVP was shown to be a safe and effective treatment, even in elderly patients with painful osteoporotic vertebral fractures.

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Multicenter Retrospective Study in Japan

Noguchi

Interventional Radiology

et al. 2021

Self Cite

Rev Osteoporos Metab Miner

“…The safety and immediate effects of PVP are well documented in the literature [23][24][25][26][27] . However, so far, there are very few data that continue to demonstrate the effectiveness and safety of this technique in the long term 28,29 .…”

Section: Discussionmentioning

confidence: 99%

Eficacia y seguridad a largo plazo del polimetilmetacrilato (PMMA) en pacientes osteoporóticos tratados mediante vertebroplastia percutánea

López‐Herradón

Piñera

Tomé³

et al. 2019

Objetive: Currently, there are limited data on the long-term influence of polymethylmethacrylate (PMMA) on the integrity of vertebral bodies after percutaneous vertebroplasty (PVP). Interesting investigation is being carried out into the possible relationship between this technique and the appearance over time of osteolytic phenomena or cement fragmentation in the intervened vertebrae. The objective of our study was to investigate whether there is a loss of effectiveness and/or safety of PVP with PMMA in the long term. Material and methods: X-rays were analyzed of intervened patients corresponding to the immediate post-operative and the most recent radiological study (PVP more than 15 years previous). With both radiological studies, we describe: the height of the vertebral body, the angulation of lamellar plates and osteolytic presence around the cement over time. Results: A total of 7 patients operated by PVP with PMMA 15 or more years earlier agreed to have a new radiograph in our center. After the analysis of their post-operative images (immediate and 15 or more years after surgery), no loss of height of the cemented vertebral body, differences in angulation in the lamellar plates, presence of osteolysis around the vertebrae was observed in any of the involved vertebrae cement or fragmentation of the injected PMMA. Conclusion: PMMA injected into the vertebral body remains stable over time (more than 15 years). There are no changes in the bone-PMMA interface, osteolysis and/or changes in the height of the vertebral bodies in the cases analyzed.

“…9,10 Studies evaluating cement augmentation of compression fractures have shown that older geriatric patients do benefit from cement augmentation procedures. 11,12 DePalma et al 11 followed 123 vertebroplasty patients and found similar rates of recurrent fracture between nonagenarian and younger patients. Kamei et al 12 retrospectively reviewed the postoperative courses of 130 vertebroplasty patients and found that nonagenarian patients had similar 1-year survival rates to younger patients.…”

Section: Introductionmentioning

confidence: 94%

“…11,12 DePalma et al 11 followed 123 vertebroplasty patients and found similar rates of recurrent fracture between nonagenarian and younger patients. Kamei et al 12 retrospectively reviewed the postoperative courses of 130 vertebroplasty patients and found that nonagenarian patients had similar 1-year survival rates to younger patients. Both of these studies were limited by relatively small patient numbers, single-center design, and failure to assess short-term postprocedure adverse outcomes.…”

Section: Introductionmentioning

confidence: 94%

Cement Augmentation of Vertebral Compression Fractures May Be Safely Considered in the Very Elderly

et al. 2021

Objective:The objective of the current study was to perform a retrospective review of a national database to assess the safety of cement augmentation for vertebral compression fractures in geriatric populations in varying age categories. Methods: The 2005-2016 National Surgical Quality Improvement Program databases were queried to identify patients undergoing kyphoplasty or vertebroplasty in the following age categories: 60-69, 70-79, 80-89, and 90+ years old. Demographic variables, comorbidity status, procedure type, provider specialty, inpatient/outpatient status, number of procedure levels, and periprocedure complications were compared between age categories using chi-square analysis. Multivariate logistic regressions controlling for patient and procedural variables were then performed to assess the relative periprocedure risks of adverse outcomes of patients in the different age categories relative to those who were 60-69 years old. Results: For the 60-69, 70-79, 80-89, and 90+ years old cohorts, 486, 822, 937, and 215 patients were identified, respectively. After controlling for patient and procedural variables, 30day any adverse events, serious adverse events, reoperation, readmission, and mortality were not different for the respective age categories. Cases in the 80-to 89-year-old cohort were at increased risk of minor adverse events compared to cases in the 60-to 69-year-old cohort. Conclusion:As the population ages, cement augmentation is being considered as a treatment for vertebral compression fractures in increasingly older patients. These results suggest that even the very elderly may be appropriately considered for these procedures (level of evidence: 3).