A 7-YEARS EXPERIENCE OF PERCUTANEOUS VERTEBROPLASTY FOR OSTEOPOROTIC VERTEBRAL FRACTURES: ANALYSIS OF FACTORS DETERMINING OUTCOME IN 212 PATIENTS

Background: Percutaneous vertebroplasty is a therapeutic procedure performed for persistent pain from osteioporotic vertebral compression fractures. However, the patient population that are most likely to benefit from this procedure is uncertain.Objectives: To determine the factors affecting the outcome of percutaneous vertebroplasty for the treatment of persistent painful osteoporotic fractures.Methods: A retrospective review of 212 patients who underwent percutaneous vertebroplasty for osteoporotic fracture at 325 levels. Age, sex, level of fracture, number of vertebrae treated, bone mineral density, duration of symptoms, vertebral body height, MRI imaging, bone scan imaging, preprocedural ASA staging and the presence of cement leaks at post procedural CT were analyzed as parameters for prognosis significance by univariate analysis. Multivariate analysis with logistic regression was employed in 127 patients with only one level affected, to estimate the strength of influence of each variable. Excellent outcome was defined as subjective decreased in pain severity below 3 in a visual analogue scale (VAS). VAS between 4 and 6 was considered as a good result, and VAS above 7 was considering a poor result.Results: Preprocedural VAS was 8,65 (range 6-10), decreasing to 2,93 (range 0-8) after the vertebroplasty. VAS scale decreased to less than 3 in 66% of the patients and to 4-6 in 25% of the cases. Scores improved in 5% of cases in last follow-up examination (mean 14,5 months, range 3-75 months). The sex female (p=0,045), the presence of less than 2 symptomatic vertebrae (p<0,01), the age of fracture less than 5 months (p<0,01), the ASA status of I (p<0,01), increased activity revealed by bone scan imaging (p<0,01), the presence of signal changes on MRI (0,01) and the collapse of the vertebral body less than 70% (p<0,01) were assessed as parameters for prognosis significance. Multivariate analysis also showed a significant correlation between MRI changes and collapse of the vertebral body and the final outcome (p<0,01). CT demonstrated that only 30% had no extravasations of the cement. In most cases extravasations was to the epidural plexus (43%), however, the presence of this cement was not related with the functional outcome.Conclusion: Percutaneous vertebroplasty is very efficient procedure for pain refractory to conservative treatment secondary to osteoporotic vertebral fracture. Better results can be expected when level treated is confirmed by MRI and/or bone scan and the lost of height of the vertebral body is less than 70%.Citation: , volume , supplement , year 2003, page Session: Osteoporosis – Clinical aspects and treatment 2