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 follow-up 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.
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Alvarez L, Alcaraz M, Perez-Higueras A, Granizo JJ, de Miguel I, Rossi RE, Quinones D (2006) Percutaneous vertebroplasty. Functional improvement in patients with osteoporotic compression fractures. Spine 31(10):1113–1118
Van der Klift M, De Laet CE, McCloskey EV, Hofman A, Pols HA (2002) The incidence of vertebral fractures in men and women: the Rotterdam Study. J Bone Miner Res 17:1051–1056
Finnern HW, Sykes DP (2003) The hospital costs of vertebral fractures in the EU. Osteoporos Int 14:429–436
Riggs BL, Melton LJ (1995) The worldwide problem of osteoporosis: insight afforded by epidemiology. Bone Suppl 5:S505–S511
Riggs BL, Melton LJ (1986) Involutional osteoporosis. N Engl J Med 314(26):1676–1685
Cohen LD (1990) Fractures of the osteoporotic spine. Orthop Clin N Am 21(1):143–150
Phillips FM (2003) Minimally invasive treatments of osteoporotic vertebral compression fractures. Spine 28(15S):S45–S53
Silverman SL (1992) The clinical consequences of vertebral compression fracture. Bone 13(Suppl 2):S27–S31
Shen WJ, Shen YS (1999) Nonsurgical treatment of three-column thoracolumbar junction burst fractures without neurologic deficit. Spine 24:412–415
Lau E, Ong K, Kurtz S, Schmier J, Edidin A (2008) Mortality following the diagnosis of a vertebral compression fracture in the medicare population. J Bone Jt Surg Am 90:1479–1486
Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR (1999) Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 159:1215–1220
Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882
Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jönsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42
Been HD, Poolman RW, Ubags LH (2004) Clinical outcome and radiographic results after surgical treatment of post/traumatic thoracolumbar kyphosis following simple type A fractures. Eur Spine J 13:101–107
Magerl F et al (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201
Galibert P, Deramond H, Rosat P, Le Gars D (1987) Note préliminaire sur le traitement des angiomes vertébraux par vertébroplastie percutanée. Neurochirurgie 33:166–168
Diamond TH, Champion B, Clark WA (2003) Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 114:257–265
Heini PF, Walchli B, Berlemann U (2000) Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J 9:445–450
Kobayashi K, Shimoyama K, Nakamura K, Murata K (2005) Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients. Eur Radiol 15:360–367
Liliang PC, Su TM, Liang CL, Chen HJ, Tsai YD, Lu K (2005) Percutaneous vertebroplasty improves pain and physical functioning in elderly osteoporotic vertebral compression fracture patients. Gerontology 51:34–39
McKiernan F, Faciszewski T, Jensen R (2004) Quality of life following vertebroplasty. J Bone Jt Surg Am 86-A:2600–2606
Barr JD, Barr MS, Lemley TJ, McCann RM (2000) Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 25:923–928
Perez-Higueras A, Alvarez L, Rossi R, Quinones D, Al-Assir I (2002) Percutaneous vertebroplasty: long term clinical and radiological outcome. Neuroradiology 44:950–954
Tohmeh AG, Mathis JM, Fenton DC, Levine AM, Belkoff SM (1999) Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of vertebral osteoporotic fractures. Spine 24:1772–1776
Berlemann U, Ferguson SJ, Nolte LP, Heini PF (2002) Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Jt Surg Br 84-B:748–752
Buchbinder R; Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. New Engl J Med 361(6):557–568
Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361(6):569–579
Klazen CA, Verhaar HJ, Lampmann LE, Juttmann JR, Blonk MC, Jansen FH, Tielbeek AV, Schoemaker MC, Buskens E, van der Graaf Y, Janssens X, Fransen H, van Everdingen KJ, Muller AF, Mali WP, Lohle PN (2007) VERTOS II: percutaneous vertebroplasty versus conservative therapy in patients with painful osteoporotic vertebral compression fractures; rationale, objectives and design of a multicenter randomized controlled trial. Trials 8:33
Jarvik JG, Hollingworth W (2007) VERTOS: a step in the right direction. AJNR Am J Neuroradiol 28(3):561–562
Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 373(9668):1016–1024
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Brodano, G.B., Amendola, L., Martikos, K. et al. Vertebroplasty: benefits are more than risks in selected and evidence-based informed patients. A retrospective study of 59 cases. Eur Spine J 20, 1265–1271 (2011). https://doi.org/10.1007/s00586-011-1705-x
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DOI: https://doi.org/10.1007/s00586-011-1705-x