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Clinical Outcome and Safety of Multilevel Vertebroplasty: Clinical Experience and Results

CardioVascular and Interventional Radiology volume 36, pages 183–191 (2013)Cite this article

Abstract

Purpose

To compare safety and efficacy of percutaneous vertebroplasty (PVP) when treating up to three vertebrae or more than three vertebrae per session.

Materials and Methods

We prospectively compared two groups of patients with symptomatic vertebral fractures who had no significant response to conservative therapy. Pathologic substrate included osteoporosis (n = 77), metastasis (n = 24), multiple myeloma (n = 13), hemangioma (n = 15), and lymphoma (n = 1). Group A patients (n = 94) underwent PVP of up to three treated vertebrae (n = 188). Group B patients (n = 36) underwent PVP with more than three treated vertebrae per session (n = 220). Decreased pain and improved mobility were recorded the day after surgery and at 12 and 24 months after surgery per clinical evaluation and the use of numeric visual scales (NVS): the Greek Brief Pain Inventory, a linear analogue self-assessment questionnaire, and a World Health Organization questionnaire.

Results

Group A presented with a mean pain score of 7.9 ± 1.1 NVS units before PVP, which decreased to 2.1 ± 1.6, 2.0 ± 1.5 and 2.0 ± 1.5 NVS units the day after surgery and at 12 and 24 months after surgery, respectively. Group B presented with a mean pain score of 8.1 ± 1.3 NVS units before PVP, which decreased to 2.2 ± 1.3, 2.0 ± 1.5, and 2.1 ± 1.6 NVS units the day after surgery and at 12 and 24 months after surgery, respectively. Overall pain decrease and mobility improvement throughout the follow-up period presented no statistical significance neither between the two groups nor between different underlying aetiology. Reported cement leakages presented no statistical significance between the two groups (p = 0.365).

Conclusion

PVP is an efficient and safe technique for symptomatic vertebral fractures independently of the vertebrae number treated per session.

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References

  1. Riggs BL, Meltron LJ III (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17(Suppl 5):505S–511S

    PubMed  Article  CAS  Google Scholar 

  2. Silverman SL (1992) The clinical consequences of vertebral compression fracture. Bone 13(Suppl 2):27–31

    Article  Google Scholar 

  3. Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE (1997) Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral compression fractures: technical aspects. Am J Neuroradiol 18:1897–1904

    PubMed  CAS  Google Scholar 

  4. Mathis JM, Barr JD, Belkoff SM, Barr MS, Jensen ME, Deramond H (2001) Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. Am J Neuroradiol 22:373–381

    PubMed  CAS  Google Scholar 

  5. Cortet B, Cotten A, Boutry N et al (1999) Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol 26(10):2222–2228

    PubMed  CAS  Google Scholar 

  6. Cook DJ, Guyatt GH, Adachi JD, Clifton J, Griffith LE, Epstein RS et al (1993) Quality of life issues in women with vertebral fractures due to osteoporosis. Arthritis Rheum 36(6):750–756

    PubMed  Article  CAS  Google Scholar 

  7. Gold DT (1996) The clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone 18(Suppl 3):185–189

    Article  Google Scholar 

  8. Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Grunze M et al (1998) Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 8(3):261–267

    PubMed  Article  CAS  Google Scholar 

  9. Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR (1999) Vertebral fractures and mortality in older women: a prospective study. Arch Intern Med 159(11):1215–1220

    PubMed  Article  CAS  Google Scholar 

  10. Amar AP, Larsen DW, Esnaashari N, Albuquerque FC, Lavine SD, Teitelbaum GP (2001) Percutaneous transpedicular polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures. Neurosurgery 49(5):1105–1114

    PubMed  CAS  Google Scholar 

  11. Galibert P, Deramond H, Rosat P, Le Gars D (1087) Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 33:166–168

    Google Scholar 

  12. Gangi A, Sabharwal T, Irani F et al (2006) Quality assurance guidelines for percutaneous vertebroplasty. Cardiovasc Intervent Radiol 29:173–178

    PubMed  Article  Google Scholar 

  13. McGraw JK, Candella J, Barr JD et al (2003) Society of Interventional Radiology Quality Improvement Guidelines for Percutaneous Vertebroplasty. J Vasc Interv Radiol 14:827–831

    PubMed  Article  Google Scholar 

  14. Mystekidou K, Mendoza T, Tsilika E et al (2001) Greek brief pain inventory: validation and utility in cancer pain. Oncology 60:35–42

    Article  Google Scholar 

  15. Cleeland CS (1989) Measurement of pain by subjective report. In: Chapman LJ, Loeser JD (eds) Advances in pain research and therapy, vol 12. Raven Press, New York, pp 391–403

    Google Scholar 

  16. Doyle D, Hans GWC, MacDonald N (1995) Pain assessment and cancer pain syndromes. In: Oxford textbook of palliative medicine. Oxford University Press, Oxford, p 148

  17. Mendoza T, Chen C, Brugger A et al (2004) The utility and validity of the modified brief pain inventory in a multiple-dose postoperative analgesic trial. Clin J Pain 20(5):357–362

    PubMed  Article  Google Scholar 

  18. Coates A, Dillenbeck CF, McNeil DR et al (1983) Linear analogue self-assessment (LASA) in evaluation of aspects of quality of life of cancer patients receiving therapy. Eur J Clin Oncol 19:1633–1637

    Article  CAS  Google Scholar 

  19. Gough IR, Furnival CM, Schilder L, Grove W (1983) Assessment of the quality of life of patients with advanced cancer. Eur J Clin Oncol 19(8):1161–1165

    Article  CAS  Google Scholar 

  20. Hurny C, Bernhard J, Coates A et al (1996) Responsiveness of a single-item indicator versus a multi-item scale: assessment of the emotional well-being in an international adjuvant breast cancer trial. Med Care 34(3):234–248

    PubMed  Article  CAS  Google Scholar 

  21. Padilla GV, Grant MM, Ferrell BR, et al. (1996) Quality of life—Cancer. In: Spiker B (ed) Quality of life and pharmacoeconomics in clinical trials, 2nd edn. Lippincott-Raven, Philadelphia

  22. Roila F, Lupatteli M, Basurto C et al (1991) Intra and interobserver variability in cancer patients’ performance status assessed according to Karnofsky and ECOG scales. Ann Oncol 2(6):437–439

    PubMed  CAS  Google Scholar 

  23. Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    PubMed  Article  CAS  Google Scholar 

  24. Anselmetti GC, Corrao G, Monica PD et al (2007) Pain relief following percutaneous vertebroplasty: Results of a series of 283 consecutive patients treated in a single institution. Cardiovasc Interv Radiol 30(3):441–447

    Article  Google Scholar 

  25. McGraw JK, Lippert J, Minkus K et al (2002) Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty. J Vasc Interv Radiol 13:883–886

    PubMed  Article  Google Scholar 

  26. Zoarski GH, Snow P, Olan WJ et al (2002) Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long term outcomes. J Vasc Interv Radiol 13:139–148

    PubMed  Article  Google Scholar 

  27. Singh AK, Pilgram TK, Gilula LA (2006) Osteoporotic compression fractures: outcomes after single- versus multiple-level percutaneous vertebroplasty. Radiology 238:211–220

    PubMed  Article  Google Scholar 

  28. Voormolen MH, Lohle PN, Lampmann LE, van den Wildenberg W, Juttmann JR, Diekerhof CH et al (2006) Prospective clinical follow-up after percutaneous vertebroplasty in patients with painful osteoporotic vertebral compression fractures. J Vasc Interv Radiol 17(8):1313–1320

    PubMed  Article  Google Scholar 

  29. Weill A, Chiras J, Simon JM et al (1996) Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology 199(1):241–247

    PubMed  CAS  Google Scholar 

  30. Cotten A, Dewatre F, Cortet B et al (1996) Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at the clinical follow-up. Radiology 200:525–530

    PubMed  CAS  Google Scholar 

  31. Shimony JS, Gilula LA, Zeller AJ, Brown DB (2004) Percutaneous vertebroplasty for malignant compression fractures with epidural involvement. Radiology 232:846–853

    PubMed  Article  Google Scholar 

  32. Barr JD, Barr MS, Lemley TJ, McCann RM (2000) Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 25(8):923–928

    PubMed  Article  CAS  Google Scholar 

  33. Murphy KJ, Deramond H (2000) Percutaneous vertebroplasty in benign and malignant disease. Neuroimaging Clin N Am 10(3):535–545

    PubMed  CAS  Google Scholar 

  34. Hulme PA, Krebs J, Ferguson SJ, Berlemann U (2006) Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine 31(17):1983–2001

    PubMed  Article  Google Scholar 

  35. Layton KF, Thielen KR, Koch CA, Luetmer PH, Lane JI, Wald JT et al (2007) Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. Am J Neuroradiol 28(4):683–689

    PubMed  CAS  Google Scholar 

  36. Uppin AA, Hirsch JA, Cantenera LV et al (2003) Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226:119–124

    PubMed  Article  Google Scholar 

  37. Tanigawa N, Komemushi A, Kariya S et al (2006) Radiological follow-up of new compression fractures following percutaneous vertebroplasty. Cardiovasc Interv Radiol 29:92–96

    Article  Google Scholar 

  38. Mubin IS, Neel AP, Solomon J et al (2005) New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women. Am J Neuroradiol 26:1601–1604

    Google Scholar 

  39. Voormolen MH, Lohle PN, Juttmann JR, van der Graaf Y, Fransen H, Lampmann LE (2006) The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty. J Vasc Interv Radiol 17(1):71–76

    PubMed  Article  Google Scholar 

  40. Kim SH, Kang HS, Choi JA, Ahn JM (2004) Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol 45(4):440–445

    PubMed  Article  CAS  Google Scholar 

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Affiliations

  1. Second Department of Radiology, Athens University School of Medicine, Attikon University Hospital, 12462, Athens, Greece

    Leto Mailli, Dimitrios K. Filippiadis, Elias N. Brountzos, Efthymia Alexopoulou, Nikolaos Kelekis & Alexios Kelekis

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  1. Leto Mailli
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  2. Dimitrios K. Filippiadis
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Correspondence to Leto Mailli.

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Mailli, L., Filippiadis, D.K., Brountzos, E.N. et al. Clinical Outcome and Safety of Multilevel Vertebroplasty: Clinical Experience and Results. Cardiovasc Intervent Radiol 36, 183–191 (2013). https://doi.org/10.1007/s00270-012-0379-z

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  • DOI: https://doi.org/10.1007/s00270-012-0379-z

Keywords

  • Vertebroplasty
  • Multilevel
  • Metastasis
  • Osteoporosis
  • Multiple myeloma