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Vascular: Percutaneous Vertebroplasty Good Choice for Severe Compression Fractures

Results outweigh technical demand and higher procedural risk

Percutaneous vertebroplasty is a feasible and effective treatment for very severe osteoporotic vertebral compression fractures, according to a study published recently in the Journal of Vascular and Interventional Radiology.

Debate about the risk and benefit of percutaneous vertebroplasty (PVP) is ongoing, especially in patients with very severe osteoporotic vertebral compression fractures (vsOVCFs, where vertebral body collapse is to less than one-third of the original height). The authors of the current study therefore sought to assess technical success and clinical outcome. Between August 2002 and October 2008 they identified 34 patients—28 women, mean age 75.5 years—with 37 vsOVCFs. PVP was performed using conscious sedation on a biplane angiography unit. The surgeon conducted a bone biopsy using a 10-gauge vertebroplasty needle and then injected polymethyl methacrylate bone cement. Injection lasted until a symmetric filling of the central and anterior parts of the vertebral body was achieved, or until cement leakage was noted. Patients completed preoperative and postoperative questionnaires regarding back pain, satisfaction, and quality of life.

After seven days, there was a significant decrease in average and worst back pain of 2.5 and 3 points respectively; after 12 months, there was a significant decrease in average and worst back pain of 2.5 and 2.9 points respectively. Both physical and mental health scores increased significantly after PVP and patient satisfaction was significantly above indifference. After a mean of 3.2 months of follow up, 17 new OVCFs in 11 patients developed and five patients had repeat PVP. There was only one minor complication. “Our results show that patients with painful vsOVCFs can be treated with and benefit from PVP...PVP is technically feasible and should not be withheld from properly selected patients,” the authors conclude.

Source: Nieuwenhuijse MJ, van Erkel AR, Dijkstra S. 2011. Percutaneous vertebroplasty in very severe osteoporotic vertebral compression fractures: feasible and beneficial. Journal of Vascular and Interventional Radiology 22:1017-1023.