DOI QR코드

DOI QR Code

The Prognostic Factors Influencing on the Therapeutic Effect of Percutaneous Vertebroplasty in Treating Osteoporotic Vertebral Compression Fractures

  • Ryu, Kyeong-Sik (Department of Neurosurgery, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Park, Chun-Kun (Department of Neurosurgery, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • Published : 2009.01.28

Abstract

Objective : This retrospective study of 215 patients with 383 symptomatic osteoporotic vertebral compression fractures (VCFs) treated by percutaneous vertebroplasty (PVP), was performed to evaluate the clinical outcomes, and to analyze the various clinical factors affecting these results. Methods : The authors assessed the clinical outcome under the criteria such as the pain improvement, activity, requirement of analgesics, and the patient's satisfaction, and determined the relation to various peri- and intra-operative factors, and postoperative imaging findings. Results : The outcome was determined as 84.2% in relief of pain, 72.0% in change in activity, 65.7% in analgesics use, and 84.7% of satisfaction rate. More severe focal back pain, high uptake bone scan, and the lower mean T-score were related to the better pain relief following PVP. The longer the duration between fracture and PVP, the less severe focal back pain, low uptake bone scan, and leakage of PMMA into the paravertebral space were related to the less improvement in activity. Female and low uptake bone scan showed a correlation with more analgesic use. The longer the duration between fracture and PVP, low uptake bone scan, and the higher the mean T-score were correlated with the less the patients satisfaction. Conclusion : Our study suggests that PVP may be more effective in the acute phase of VCFs, more severe focal pain, and far advanced osteoporosis on BMD. Leakage of PMMA into the paravertebral spcae also could be affecting the surgical results.

Keywords

References

  1. Amar AP, Larsen DW, Esnaashari N, Albuquerque FC, Lavine SD, Teitelbaum GP : Percutaneous transpedicular polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures. Neurosurgery 49 : 1105-1114 ; discussion 1114-1105, 2001 https://doi.org/10.1097/00006123-200111000-00017
  2. Baroud G, Vant C, Wilcox R : Long-term effects of vertebroplasty : adjacent vertebral fractures. J Long Term Eff Med Implants 16 : 265-280, 2006 https://doi.org/10.1615/JLongTermEffMedImplants.v16.i4.10
  3. Boger A, Heini P, Windolf M, Schneider E : Adjacent vertebral failure after vertebroplasty : a biomechanical study of low-modulus PMMA cement. Eur Spine J 16 : 2118-2125, 2007 https://doi.org/10.1007/s00586-007-0473-0
  4. Cortet B, Cotten A, Boutry N, Flipo RM, Duquesnoy B, Chastanet P, et al : Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures : an open prospective study. J Rheumatol 26 : 2222-2228, 1999
  5. Dean JR, Ison KT, Gishen P : The strengthening effect of percutaneous vertebroplasty. Clin Radiol 55 : 471-476, 2000 https://doi.org/10.1053/crad.2000.0478
  6. Deen HG, Aranda-Michel J, Reimer R, Putzke JD : Preliminary results of balloon kyphoplasty for vertebral compression fractures in organ transplant recipients. Neurosurg Focus 18 : e6, 2005
  7. Deramond H, Depriester C, Galibert P, Le Gars D : Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am 36 : 533-546, 1998 https://doi.org/10.1016/S0033-8389(05)70042-7
  8. Dunnagan SA, Knox MF, Deaton CW : Osteoporotic compression fracture with persistent pain. Treatment with percutaneous vertebroplasty. J Ark Med Soc 96 : 258-259, 1999
  9. Frankel BM, Monroe T, Wang C : Percutaneous vertebral augmentation : an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty. Spine J 7 : 575-582, 2007 https://doi.org/10.1016/j.spinee.2006.10.020
  10. Gangi A, Dietemann JL, Schultz A, Mortazavi R, Jeung MY, Roy C : Interventional radiologic procedures with CT guidance in cancer pain management. Radiographics 16 :1289-1304 ; discussion 1304- 1286, 1996 https://doi.org/10.1148/radiographics.16.6.8946536
  11. Garfin SR, Yuan HA, Reiley MA : New technologies in spine : kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 26 : 1511-1515, 2001 https://doi.org/10.1097/00007632-200107150-00002
  12. Heini PF, Berlemann U, Kaufmann M, Lippuner K, Fankhauser C, van Landuyt P : Augmentation of mechanical properties in osteoporotic vertebral bones : a biomechanical investigation of vertebroplasty efficacy with different bone cements. Eur Spine J 10 : 164- 171, 2001 https://doi.org/10.1007/s005860000204
  13. Jensen ME, Dion JE : Percutaneous vertebroplasty in the treatment of osteoporotic compression fractures. Neuroimaging Clin N Am 10 : 547-568, 2000
  14. Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR : Vertebral fractures and mortality in older women : a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 159 : 1215-1220, 1999 https://doi.org/10.1001/archinte.159.11.1215
  15. Kaufmann TJ, Jensen ME, Schweickert PA, Marx WF, Kallmes DF : Age of fracture and clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol 22 : 1860-1863, 2001
  16. Kim SH, Kang HS, Choi JA, Ahn JM : Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol 45 : 440-445, 2004 https://doi.org/10.1080/02841850410005615
  17. Liebschner MA, Rosenberg WS, Keaveny TM : Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine 26 : 1547-1554, 2001 https://doi.org/10.1097/00007632-200107150-00009
  18. Maynard AS, Jensen ME, Schweickert PA, Marx WF, Short JG, Kallmes DF : Value of bone scan imaging in predicting pain relief from percutaneous vertebroplasty in osteoporotic vertebral fractures. AJNR Am J Neuroradiol 21 : 1807-1812, 2000
  19. O'Brien J, Brennan D, Taylor D, O'Byrne J, Eustace S : Percutaneous vertebroplasty--initial clinical experience in osteoporotic and myelomatous compression fractures. Ir J Med Sci 175 : 50-53, 2006
  20. Ross PD : Clinical consequences of vertebral fractures. Am J Med 103 : 30S-42S ; discussion 42S-43S, 1997 https://doi.org/10.1016/S0002-9343(97)90025-5
  21. Ryu KS, Park CK, Kim MC, Kang JK : Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Neurosurg 96 : 56-61, 2002
  22. Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Grunze M, et al : Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 8 : 261-267, 1998 https://doi.org/10.1007/s001980050063
  23. Silverman SL : The clinical consequences of vertebral compression fracture. Bone 13 Suppl 2 : S27-S31, 1992 https://doi.org/10.1016/8756-3282(92)90193-Z
  24. Tohmeh AG, Mathis JM, Fenton DC, Levine AM, Belkoff SM : Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures. Spine 24 :1772-1776, 1999 https://doi.org/10.1097/00007632-199909010-00004
  25. Watts NB, Harris ST, Genant HK : Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty. Osteoporos Int 12 : 429-437, 2001 https://doi.org/10.1007/s001980170086

Cited by

  1. An Objection to the New England Journal of Medicine Vertebroplasty Articles vol.61, pp.2, 2010, https://doi.org/10.1016/j.carj.2010.01.010
  2. Clinical Utility of Vertebroplasty: Need for Better Evidence vol.255, pp.3, 2010, https://doi.org/10.1148/radiol.10092107
  3. The Proper Volume and Distribution of Cement Augmentation on Percutaneous Vertebroplasty vol.48, pp.2, 2009, https://doi.org/10.3340/jkns.2010.48.2.125
  4. The Role of Bone Cement Augmentation in the Treatment of Chronic Symptomatic Osteoporotic Compression Fracture vol.48, pp.6, 2010, https://doi.org/10.3340/jkns.2010.48.6.490
  5. Correlation of Kyphosis and Wedge Angles with Outcome after Percutaneous Vertebroplasty: A Prospective Cohort Study vol.19, pp.1, 2009, https://doi.org/10.1177/230949901101900108
  6. The Association between the Duration of Preoperative Pain and Pain Improvement in Vertebral Augmentation: A Meta-Analysis vol.33, pp.2, 2009, https://doi.org/10.3174/ajnr.a2618
  7. Vertebroplasty and kyphoplasty—A systematic review of cement augmentation techniques for osteoporotic vertebral compression fractures compared to standard medical therapy vol.72, pp.1, 2009, https://doi.org/10.1016/j.maturitas.2012.02.010
  8. The Clinical Characteristics of Lower Lumbar Osteoporotic Compression Fractures Treated by Percutaneous Vertebroplasty : A Comparative Analysis of 120 Cases vol.10, pp.4, 2009, https://doi.org/10.14245/kjs.2013.10.4.221
  9. Comparative review of vertebroplasty and kyphoplasty vol.6, pp.6, 2009, https://doi.org/10.4329/wjr.v6.i6.329
  10. Calcium Phosphate Scaffolds Combined with Bone Morphogenetic Proteins or Mesenchymal Stem Cells in Bone Tissue Engineering vol.128, pp.8, 2009, https://doi.org/10.4103/0366-6999.155121
  11. A PRELIMINARY IN VITRO BIOMECHANICAL EVALUATION OF PROPHYLACTIC CEMENT AUGMENTATION OF THE THORACOLUMBAR VERTEBRAE vol.16, pp.5, 2009, https://doi.org/10.1142/s0219519416500743