Clinical Studies
Prospective Evaluation of Pain Relief in 100 Patients Undergoing Percutaneous Vertebroplasty: Results and Follow-up

https://doi.org/10.1016/S1051-0443(07)61770-9Get rights and content

PURPOSE

To determine the efficacy and durability of percutaneous vertebroplasty for the treatment of back pain associated with vertebral body compression fractures.

MATERIALS AND METHODS

One hundred patients (79 women, 21 men; mean age, 73.7 y) underwent 156 percutaneous injections of polymethylmethacrylate (PMMA) into a vertebra (68 thoracic and 88 lumbar) under fluoroscopic guidance over a 35-month period. Before the procedure and at follow-up, patients were asked to quantify their pain on a visual analog scale (VAS) and complete a follow-up questionnaire of our own design.

RESULTS

The procedure was technically successful in all patients. There were two complications. One patient sustained a sternal fracture and one experienced a transient radiculopathy. Ninety-seven patients (97%) reported significant pain relief 24 hours after treatment. Mean follow-up duration was 21.5 months (6–44 mo) in 99 patients. Ninety-two patients (93%) reported significant improvement in back pain previously associated with their compression fractures as well as improved ambulatory ability. Before vertebroplasty, the VAS score for the 99 patients was 8.91 ± 1.12 compared to a score of 2.02 ± 1.95 at follow-up. The mean difference in VAS scores was significant (P < .0001).

CONCLUSION

Percutaneous vertebroplasty of symptomatic vertebral body compression fractures is a minimally invasive procedure that provides immediate and sustained pain relief in patients with refractory pain.

Section snippets

Study Population

A prospective study was undertaken over a 35-month period in which 100 consecutive patients were treated at a single institution. Institutional review board approval was obtained. Twenty-one men and 79 women with a mean age of 73.7 years (37–94 y) were treated. One hundred fifty-six vertebral bodies were treated (68 thoracic, 88 lumbar).

The indication for percutaneous vertebroplasty was painful vertebral body compression fracture(s) refractory to medical therapy. Failure of medical therapy was

RESULTS

We were technically successful in all treated vertebrae. At 12–24 hours, patients were seen and asked to subjectively report their pain as being improved, unchanged, or worse than before the procedure. Ninety-seven percent (97 of 100 patients) reported improvement and three patients reported their condition unchanged. There were two minor adverse events and no major adverse events in our patient population. One patient sustained a sternal fracture before percutaneous vertebroplasty while

DISCUSSION

Osteoporotic compression fractures may result in severe persistent back pain. The pain can often limit mobility and impact the patient's quality of life. Conservative treatment with external bracing, analgesics, and bedrest may be all that is required for pain control in certain patients. However, patients with severe osteoporosis may continue to experience protracted pain despite these conservative measures.

PMMA has been used in spine stabilization for metastatic disease in earlier series (5, 6

CONCLUSION

Percutaneous vertebroplasty is a minimally invasive therapy in the treatment of painful compression fractures that are refractory to conservative treatment. As we have shown in our prospective study of 100 patients, the procedure restores patient mobility and provides immediate and extended pain relief of symptomatic vertebral body compression fractures. A controlled, randomized trial is now needed.

References (19)

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None of the authors has identified a conflict of interest.

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