P22. Percutaneous vertebroplasty: functional improvement in patients with osteoporotic compression fractures

Álvarez, Luis; Alcaraz, María José; Pérez-Higueras, Antonio; Miguel, Ignacio de; Izquierdo, Enrique

doi:10.1016/s1529-9430(03)00405-4

Cited by 78 publications

(118 citation statements)

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“…In the remaining studies, most SAEs were related to spinal canal/foramen cement leakage. In VP studies, three patients had postoperative paraparesis related to cement extravasation and required reoperation that reversed their symptoms [39,58]. Two patients had postoperative radiculopathy and were successfully managed non-operatively [58,62].…”

Section: Serious Adverse Eventsmentioning

confidence: 99%

Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

et al. 2012

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Purpose To determine if differences in safety or efficacy exist between balloon kyphoplasty (BKP), vertebroplasty (VP) and non-surgical management (NSM) for the treatment of osteoporotic vertebral compression fractures (VCFs). Methods As of February 1, 2011, a PubMed search (key words: kyphoplasty, vertebroplasty) resulted in 1,587 articles out of which 27 met basic selection criteria (prospective multiple-arm studies with cohorts of C20 patients).This systematic review adheres to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.Results Pain reduction in both BKP (-5.07/10 points, P \ 0.01) and VP (-4.55/10, P \ 0.01) was superior to that for NSM (-2.17/10), while no difference was found between BKP/VP (P = 0.35). Subsequent fractures occurred more frequently in the NSM group (22 %) compared with VP (11 %, P = 0.04) and BKP (11 %, P = 0.01). BKP resulted in greater kyphosis reduction than VP (4.88 vs. 1.7°, P \ 0.01). Quality of life (QOL) improvement showed superiority of BKP over VP (P = 0.04), along with a trend for disability improvement (P = 0.08). Cement extravasation was less frequent in the BKP (P = 0.01). Surgical intervention within the first 7 weeks yielded greater pain reduction than VCFs treated later. Conclusions BKP/VP provided greater pain relief and fewer subsequent fractures than NSM in osteoporotic VCFs. BKP is marginally favored over VP in disability improvement, and significantly favored in QOL improvement. BKP had a lower risk of cement extravasation and resulted in greater kyphosis correction. Despite this analysis being restricted to Level I and II studies, significant heterogeneity suggests that the current literature is delivering inconsistent messages and further trials are needed to delineate confounding variables.

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Section: Serious Adverse Eventsmentioning

confidence: 99%

Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

et al. 2012

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“…Thereafter, the procedure became popular for the management of pain associated with benign compression fractures, multiple myelomas, lymphomas, vertebral metastatic lesions, and hemangiomas [24,29]. Outstanding results are achieved using percutaneous vertebroplasty for the treatment of osteoporotic spinal compression fractures [2,6,18,20,38]. Nonetheless, acute complications are reported, such as bleeding at the puncture site, local infection, leakage of cement into the spinal canal, adjacent discs, paravertebral soft tissues, or perivertebral venous No funds were received in support of this work.…”

Section: Introductionmentioning

confidence: 99%

Revision strategies for complications and failure of vertebroplasties

Yang

Chen

et al. 2008

Eur Spine J

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Percutaneous vertebroplasty is widely discussed in the management of osteoporotic spinal compression fracture, but few reports are available concerning salvage procedures after failure of this technique. We studied 22 percutaneous vertebroplasty patients who required revision surgery upon presentation of new symptoms postoperatively. The indications for revision surgery included recurrent intractable back pain with no response to medical treatment, infectious spondylitis, cement leakage with neurologic deficit, and cement dislodgement and/ or fragmentation. Five patients underwent repeated percutaneous vertebroplasty of the initially cemented vertebrae. Seventeen patients underwent anterior, posterior, or combined anterior and posterior surgery. Four patients required a third surgical procedure because of poor augmentation with cement, subsidence of the anterior bone graft, or pullout of the instrumentation. Finally, four (18%) patients underwent repeat vertebroplasty, two (9%) patients underwent anterior surgery only, one (5%) patient underwent posterior surgery only, and 15 (68%) patients underwent combined anterior and posterior surgery; all but one regained ambulatory status equivalent to that prior to surgery. In conclusion, percutaneous vertebroplasty is a simple and effective, but not risk-or complication-free procedure for the treatment of osteoporotic spinal compression fracture. The spine surgeon should be familiar with varied approaches and techniques for revision surgery. Combined anterior and posterior surgery seems to be the most secure salvage method to treat severely osteoporotic patients in whom percutaneous vertebroplasty initially failed.

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“…It has been demonstrated that PMMA injection into the osteoporotic vertebral body increases its strength and stiffness [24,25]. A study led by Alvarez et al [1] found an increase in incidence of new fractures in the PVP group comparing with the conservative group, even if most of them were not adjacent to augmented vertebra, suggesting that it may represent the natural history of osteoporosis. Although new vertebral fractures subsequent to augmentation procedure has been described in different studies, it is still debated in literature if, and how much, PVP treatment increases the risk of adjacent vertebral fracture.…”

Section: Discussionmentioning

confidence: 99%

“…Vertebral fractures are the most common complication of osteopenia [1,2]. Almost 1 million vertebral fractures in the elderly occur each year in Europe, with health costs that amount at 337 million euro [3].…”

Section: Introductionmentioning

confidence: 99%

“…Vertebral fractures in osteoporotic patients may be of minimal degree and therefore go unnoticed, or they can cause acute and intense lumbar back pain, compromising quality of life [1]. In most cases, conservative treatment based on bed rest, bracing, physical therapy and pharmacological treatment may reduce pain intensity within a few weeks.…”

Section: Introductionmentioning

confidence: 99%

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Vertebroplasty: benefits are more than risks in selected and evidence-based informed patients. A retrospective study of 59 cases

et al. 2011

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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 followup 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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P22. Percutaneous vertebroplasty: functional improvement in patients with osteoporotic compression fractures

Cited by 78 publications

References 0 publications

Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

Revision strategies for complications and failure of vertebroplasties

Vertebroplasty: benefits are more than risks in selected and evidence-based informed patients. A retrospective study of 59 cases

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