Percutaneous vertebroplasty for symptomatic osteoporotic compression fractures: A single–center prospective study
- Department Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh.
DOI:10.25259/SNI_212_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Md. Kamrul Ahsan, Om Prakash Pandit, Md. Shahidul Islam Khan. Percutaneous vertebroplasty for symptomatic osteoporotic compression fractures: A single–center prospective study. 19-Apr-2021;12:176
How to cite this URL: Md. Kamrul Ahsan, Om Prakash Pandit, Md. Shahidul Islam Khan. Percutaneous vertebroplasty for symptomatic osteoporotic compression fractures: A single–center prospective study. 19-Apr-2021;12:176. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=10731
Background: Osteoporotic vertebral compression fractures (OVCFs) increasingly occur with advancing age, and are associated with significant morbidity, mortality, and cost. We assessed the clinical efficacy, radiological, and functional outcomes for patients undergoing percutaneous vertebroplasty (PVP) due to OVCFs, with a special focus on the frequency of new vertebral compression fractures (VCFs).
Methods: This study, carried from 2018 to 2020, included 22 females and 4 males. They averaged 60.15 years of age (range, 50–70) were followed an average of 14.5 months (range 12–36 months), and had 30 VCFs between the T7–L2 levels. Multiple variables were studied, including; anterior vertebral height (AVH) and kyphotic angle (KA), new VCFs, and functional outcomes.
Results: The postoperative Visual Analog Scale and Oswestry Disability Index were significantly reduced at 12 months after PVP. Improvements for AVH and KA were also statistically significant; 23 patients (88.46%) had a dramatic decrease in pain on post-operative day 1, while 3 patients (11.53%) had no decrease in pain after PVP on post-operative day 1–1 postoperative month. No major complications were observed except high incidence of cement leakage at 8 levels (26.67%) in 6 patients. Additionally, new VCFs occurred in 10 vertebrae in 8 patients (30.76%), involving 6 adjacent (60%), and 4 nonadjacent vertebrae (40%).
Conclusion: PVP is an effective procedure in the management of painful OVCFs refractory to medical treatment. These PVP procedures yield immediate vertebral stabilization, relieve pain, and restore function with minimal associated morbidity.
Keywords: Bone cement, Compression fracture, Osteoporosis, Vertebroplasty
Approximately 3–16% of women and 1–8% of men aged >50 years are reported to have sustained a clinically symptomatic vertebral compression fracture (VCF).[
With Institutional Review Board approval, (2018–2020) we retrospectively reviewed the charts of 22 females and 4 males with OVCS. Patients averaged 60.15 years of age, the mean follow-up period was 14.5 months, and exhibited 30 VCFs (T7–L2) [
Radiological work up
All patients underwent radiological assessment (plain X-rays, computed tomography [CT], and Magnetic resonance imaging [MRI] scans) plus laboratory investigations [
72-year-old lady underwent percutaneous vertebroplasty following osteoporotic vertebral compression fracture (VCF) at L1 level on July 28, 2018 after 8 weeks of onset of symptoms. (a and b) plain X-ray lumbosacral spine shows compression fracture L1, (c-d) T2 weighted sagittal view magnetic resonance imaging and computed tomography scan showing VCF and (e-h) shows subsequent follow up at 1, 3, 6 and at 12 months, and measurement of anterior vertebral height (increased 70% at 12 month) and kyphotic angle decrease from 15 to 6 degree.
Postoperatively, patients were evaluated utilizing Visual Analog Scale (VAS), Oswestry Disability Index (ODI) score, and radiological parameters (anterior vertebral height [AVH], kyphotic angle [KA]; plain standing X-rays on 1 day and 1, 4, 6, 12 months, and yearly thereafter) [
Measurement technique for assessing fracture kyphosis (a and b) and anterior vertebral height (c). Segmental kyphosis (a) was assessed by measuring the angle between the inferior end plate of the upper vertebra and superior end plate of the lower vertebra and vertebral kyphosis (b) by measuring the angle between the two end plates of the fractured vertebra
Routine PVP were performed under general anesthesia or local anesthesia using a C-arm. Bilateral cannulations were favored due to increase the likelihood of adequate/ safer cement injections. The routine procedures were then performed.
The quantitative data were analyzed statistically using Statistical Package for the Social Science, version 25, Armonk, NY, INM Corp. Statistical significance was set at P < 0.05 and confidence interval set at 95% level. Continuous variable was expressed as mean with standard deviation and categorical variables as frequency with percentage. Numerical data were assessed by paired t-test.
The mean post-operative VASs and ODI scores were significantly reduced at 12 months after PVP [
The efficacy of PVP in decreasing pain has been reported to be 60–90%.[
The amount of cement used during the PVP procedure is critical for its success. Recently it has been mentioned that 16% of the vertebral corpus volume should be augmented in order to balance the distribution of stress over the vertebra.[
A major problem that occurs after PVP is a new fracture in adjacent vertebra. A meta-analysis demonstrated that incidence of new fractures after PVP was 8–52%[
Vertebroplasty has a complication rate of 1–3%. The most frequently reported complications are cement extravasation. There were no major complications in the present study despite a relatively high incidence of cement leakage at 8 levels (26.67%). New VCFs occurred 10 vertebrae in 8 patients (30.76%), and one patient exhibited progressive kyphotic deformity (3.84%). In Lee et al.[
PVP is a procedure that improve stability and pain relief, and but have been associated with new fractures of adjacent vertebra versus conservative pain management.[
PVP is a safe and effective procedure in the management of painful OVCFs refractory to medical treatment. This procedure can be performed rapidly and is alternative to open surgeries in patients with comorbidities.
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