Vertebroplasty in the treatment of osteoporosis vertebral fractures: report on 52 cases

ACR appropriateness criteria management of vertebral compression fractures

This is an updated review of management of vertebral compression fracture for both benign osteoporotic and malignant causes. Vertebral compression fracture radiologic imaging evaluation is discussed. A literature review is provided of current indications for vertebral augmentation with percutaneous vertebroplasty and kyphoplasty as well as medical management. Limitations and potential benefits of these procedures are discussed. Variant tables describing various clinical situations are also provided to assist in determining appropriate use of these treatments for patient care. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to formulate recommendations for imaging or treatment.

Treatment of severe vertebral body compression fractures with percutaneous vertebroplasty

OBJECTIVE

Evaluate the efficacy of percutaneous vertebroplasty for severe vertebral body compression fractures.

METHODS

Over a period of 6 years and 8 months, 661 vertebroplasties were performed in 292 patients at our institution. Of these, 69 patients met our criteria for a severe vertebral body compression fracture defined as vertebral body collapse to less than one-third of the original height. Of the 69, 25 underwent single level vertebroplasty. Imaging features were then analyzed including location, extent of collapse, pattern of compression, pre- and post-kyphotic angle and adjacent disc height. Complications and clinical outcomes were then evaluated.

RESULTS

Involved vertebra ranged from T6 to L5 with 60% at the thoracolumbar junction. Vertebral body collapse ranged from 30 to 14% (mean 22%) of original height. Pattern of collapse included 11/ 25 (44%) plana, 8/25 (32%) gibbus, and 6/25 (24%) H-shaped. Kyphotic angle before vertebroplasty ranged from 33-0° (mean 16°) with an average correction of 1.2° after vertebroplasty. Mean disc height before vertebroplasty was 7.3 mm above and 7.7 mm below. Complications included cement leak to the adjacent disc in 16 (64%) and the paravertebral soft tissues in 3 (12%). Cement leak into the proximal azygous vein was documented in one case. International Quality of Life Questionnaire VAS was completed before and after (6 weeks) the procedure by all but six patients. Mean pre-intervention VAS was reported as 7.00 (range 5-10, SD 1.73) and mean post-intervention VAS was reported as 5.11 (range 0-9, SD 2.56), demonstrating a statistically significant improvement in pain (P < 0.015, 95% CI = 0.83-2.96) with 84% or 16/19 patients reporting some degree of improvement.

CONCLUSION

Percutaneous vertebroplasty is safe and effective in the treatment of single level severe vertebral body compression fractures.