Vertebroplasty: benefits are more than risks in selected and evidence-based informed patients. A retrospective study of 59 cases

Abstract

Vertebral compression fractures represent a frequent pathology among elderly population, with potentially devastating consequences. More than 20 years have passed since percutaneous vertebroplasty was initially used in the treatment of angiomas, representing nowadays a widely used treatment for osteoporotic vertebral fractures. The authors present a retrospective review of 59 consecutive patients (in total 94 fractured levels) that underwent polymethylmethacrylate percutaneous vertebroplasty for vertebral compression fractures due to senile or secondary osteoporosis. All fractures were free from neurologic involvement and were classified as A1 type according to Magerl classification. All of patients were initially treated conservatively, by application of orthosis that allows immediate deambulation. At control, patients who complained of pain and limitation of daily activities underwent MRI. If presence of marrow signal changes, especially hypertense signal in T2-weighted images was confirmed, percutaneous vertebroplasty procedure was performed (we could call it ''sub-acute'' procedure). A limited group of patients that did not tolerate brace and had an insufficient pain control underwent vertebroplasty ''in acute'', few days after fracture. Immediate post-operative pain reduction and follow-up clinical outcome (estimating quality of life and residual back pain) were evaluated by means of Visual Analogue Scale, SF-36 and Oswestry Disability Index. In the immediate post-operative course a significant pain relief was found in 39 patients (66.1%), moderate pain relief in 17 (28.8%), while 3 (5.1%) did not achieve relevant pain improvement. Pain intensity and life quality was maintained within satisfactory limits after a mean followup of 16 months. In conclusion, percutaneous vertebroplasty is an effective and safe procedure for treating vertebral compression fractures in the elderly. It provides immediate pain relief and allows early mobilization, thus avoiding potentially severe complications related to persistent back pain and prolonged bed rest. When performed by experienced surgeon complication rate is low, representing a safe procedure, able to provide a satisfactory outcome.

Surgical complications and unwated events in the modern percutaneous vertebroplasty treatment

“…We have retrospectively investigated 56 consecutive patients after PV at 66 levels in total (Th5 -L4) treated in our clinic for the last three years. Of them, tasis) or traumatic vertebral compression fractures (VCF), predominantly in the thoracic and lumbar region of the spine (1)(2)(3)(4)(5)(6)(7)(8)(9). The technique of PV is described for the first time by Galibert and Deramond (10) in France.…”

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2011

“…However, the saving from the procedure was related to the fact that subsequently, the kyphoplasty group were less likely to be readmitted. The long-term benefit of vertebroplasty is shown in the paper by Brodano [8], in his retrospective review of 59 patients treated with vertebroplasty between 2004 and 2007. The authors draw attention to the fact that in this elderly population the immediate pain relief is of great importance, and this was achieved in 66% of their patients, with moderate immediate pain relief in 28%.…”

Advances in the clinical research of the minimally invasive treatment for the posterior edge of vertebral-body defects by spinal metastases

“…Although PVP can significantly alleviate severe pain induced by spinal metastases, it cannot restore kyphotic deformity and abnormal changes in spinal biomechanics, which may lead to a poorly analgesic effect at a long-term time. The pain remission rate of PKP is similar with that of PVP, but PKP has the role to increase the bone strength of the vertebral body, restore vertebral height, correct kyphosis and restore normal biological force lines of spinal body (29). As PKP can increase the vertebral defect area, it would not be recommended to the patients with vertebral defects caused by metastatic cancer of the spine (30).…”