Percutaneous Vertebroplasty For The Treatment Of Osteoporotic Vertebral Compression Fractures

ObjectiveTo assess the effectiveness of percutaneous vertebroplasty for the relief of pain caused by osteoporotic vertebral compression fractures and the recovery of daily activity function. To evaluate this technique and its effectiveness in restoring the height of such fractures and the leakage of PMMA and to find out the relationship of different degree of compression and vacuum cleft to it. To investigate the occurrence rates and the related factors of new symptomatic fractures adjacent to those treated with this technique.Materials and MethodsA retrospective study was conducted to review 86 consecutive PVP procedures on 120 vertebral compression fractures. Patients must have complete data of clinic, radiograph, and follow-up. The visual analogue scale (VAS) and Owestry disability index (ODI) were recorded completely before and after (1 day, 1 month, 6 month, and 12 month) vertebroplasty. These data was analyzed using paired-samples T test. We also reviewed digital radiographs of these vertebral before and after vertebroplasty. We measured the height of the anterior border, center, and posterior border of the collapsed vertebras. The ratio of the height was calculated to the posterior border of an adjacent normal vertebral body. We divided these vertebras to four groups and two groups according to the Genant Semi-quantitative method about the degree of compression and the vacuum cleft respectively. Group A consisted of 7 vertebras, while group B, C, and D had 25, 36, 52 vertebras respectively. GroupⅠconsisted 37 (32 patients), while groupⅡhad 83 (56 patients). The increase of the anterior border, center, and posterior border were analyzed using paired-samples T test and One-Way ANVOA among four groups. When PMMA leakages present, leakage types were classified as intradiscal, perivertebral soft tissue, perivertebral venous and epidural. The number and the type of PMMA leakage in different groups were recorded. The frequencies and leakages were compares using Fisher exact tests. Special attention was paid to incidence of the new symptomatic fractures and the related factors, for example sex, age, the length of disease, degree of compression, vacuum cleft, and activity.ResultsAll procedures were completed successfully under DSA guidance. After PVP, all patients had significant pain relief and improvement of daily activity function (P<0.05) in four groups. In the following 1 month, 6 month, 12 month, patients feel well without recurrent of pain and disorder. Methods 1: The average increase about vertebral body height in four groups of anterior border, central, posterior border was 0.01±0.01cm,0.01±0.01cm,0.00±0.00cm;0.10±0.14cm,0.07±0.10cm,0.01±0.02cm; 0.22±0.22cm,0.15±0.24cm,0.02±0.03cm; 0.40±0.33cm,0.32±0.34cm,0.03±0.04cm respectively. The height of anterior border and center in D group had more increase than the other 3 groups. The increase of posterior border among these groups had no significant difference. The average frequency of PMMA leakage was 25.8%, while 14.3%, 16%, 22.2%, 34.6% in the four groups respectively. There was no significant difference about the frequency and the type of PMMA leakage among the four groups(P>0.05). Methods 2: The average increase about vertebral body height in two groups of anterior border, central, posterior border was 0.45±0.32cm, 0.29±0.31cm, 0.03±0.04cm; 0.17±0.22cm, 0.15±0.26cm, 0.02±0.04cm respectively. The increase of anterior border, center and posterior border height in these two groups was remarkable. But groupⅠwas better. The average frequency of PMMA leakage was 40.5% and 28.9% respectively. There was no significant difference about the frequency(P>0.05), but the type of PMMA leakage was different (P<0.05). Ten patients (2 men and 8 women) developed a total of 19 new symptomatic fractures within 1 year. The leakage of PMMA, the vacuum cleft and the intensity of activity after PVP are the dangerous factors.ConclusionsPercutaneous vertebroplasty is an effective treatment for osteoporotic compression fractures, which has remarkable pain relief, recovery of daily activity function, partial increase of the height, and low incidence of PMMA leakage. This study also demonstrated that a substantial number with osteoporosis develop new symptomatic fractures after undergoing percutaneous vertebroplasty. Three factors play an important role in it. We can forecast the incidence and location of the new fractures. Also, we can lessen the influence of these factors to the new fractures and give them suggestions to avoid it.