Percutaneous Vertebroplasty For The Curative Effect Of Osteoporotic Vertebral Compression Fractures

Background:With the aging population have increased year by year,age-related diseases have become an increasing concern in the community.Osteoporosis(Op) is often neglected because of their occult,universality,etc.It was not until after fracture the Op has been attention, which is called the "silent epidemic".It is a generalized,systemic skeletal disease which is characterized by osteopenia per unit volume,cataplasia of bone microarchitecture,the reduction of bone strength,increased brittleness and fracture easily.Op has many complications and the most serious is osteoporotic fracture.The common fracture sites are the spine,the hip,etc. Complications such as hypostatic pneumonia and bed sores have affected the quality of life of patients seriously and even endanger the patient's life which caused by fractures.Osteoporotic Vertebral Compression Fracture(OVCF) is common in clinical,which is an important complication of Op.OVCF is sclerotin progressing decalcification and abnormalities of bone trabecularism.Its main symptom such as low back pain,spinal kyphosis and secondary damage can affect the quality of life of the elderly seriously,which is an important reason of death.Although the medication and other conservative treatment can case symptoms,most drugs have side effects,for example,the loss of vertebral height,local kyphosis and chronic back pain.Furthermore,long-term bedridden of gerontal patients can make osteoporosis more serious which can result in bed sores and hypostatic pneumonia or even death.Conventional patency treatments are difficult to perform,because of many disadvantages.So the Percutaneous Vertebroplasty(PVP) will be used widely.PVP is a gradually developed minimally invasive spine surgery in recent years.It is a minimally invasive spine surgery technique which inject PMMA inside the vertebral body by percutaneous needle which puncture to the spinal lesion in image-guided.Through the PVP,we can achieve the objective which is to alleviate back pain,to strengthen the vertebral body strength and stability,to prevent collapse,and even the partial restoration of vertebral height. Sincethe French intervention radiologist use the technology to treat one case of patients with C2 vertebral hemangioma and obtain better treatment in 1984,PVP has been great developed.At present,PVP is often used to treat diseases such as OVCF,symptomatic vertebral hemangioma and spinal metastases.Objective:To 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.Materials and Methods:A retrospective study was conducted to review 61 consecutive PVP procedures on 103vertebral compression fractures.Patients must have complete data of clinic,radiograph,and follow-up.The visual analogue scale(VAS) and Owestry disability index were recorded completely before and after(1 day,1 month,3 month,6 month and 12 month) vertebroplasty.We divided these vertebras to four groups according to the Genant Semi-quantitative method about the degree of compression and the vacuum cleft respectively. Group A consisted of 4 vertebras,while group B,C,and D had 20,31,48 vertebras respectively. We measured Cobb's angle and the height of the anterior border,center,and posterior border of the collapsed vertebras and analysis the effect of the degree of centrum for the restoration of vertebral height.The number and the type of PMMA leakage in different groups were recorded. We calculate the vertebral fracture rate of leakage and leakage types and analysis the effect of the degree of centrum for the leakage and the clinical symptom caused by the leakage.Results:1.All 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.2.The average increase about vertebral body height in four groups of anterior border, central,posterior border was 0.15±0.13mm,0.08±0.09mm,0.08±0.05mm;1.0±0.16mm,0.03±0.10mm,0.1±0.1mm;1.61±0.36mm,2.39±0.28mm,0.05±0.17mm;3.33±0.20mm,3.03±0.10mm,0.05±0.17mm respectively.The height of anterior border and center in A group had less increase than the other 3 groups.The increase of posterior border among these groups had no significant difference.Cobb's angle changes in vertebral body and the degree of vertebral compression among these groups were statistically significant.3.The PMMA leakage were 14.3%,16%,22.2%and 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).Conclusions:Percutaneous vertebroplasty is an effective treatment for osteoporotic compression fractures,which has remarkable pain relief,recovery of daily activity function, partial increase of the height,especially the more compression.But the risk of occurrence of PMMA leakage will be greatly increased when we increase the PMMA in order to reduce vertebra.PVP has many advantages and significance in the condition of our country which have poor economic and medical resources relatively.Therefore,PVP is more suitable in developing country.The PMMA leakage will be hold if we can master the indication and contraindication strictly,make good preparation for the preoperative and operate seriously.