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Pathologic versus Osteoporotic Compression Fractures: Is there a difference in response to vertebroplasty? 2012

Interventional Spine

Lex, A, Mitchell, MD
Mike, Ross, MD, Non ASSR Member
Alyson, Wu, MD, Non ASSR Member
Huy, M, Do, MD, Non ASSR Member

Paper/Non-Mentor

Purpose

Vertebroplasty (VP) is a minimally invasive outpatient procedure where vertebral compression fractures are injected with polymethyl methacrylate (PMMA) to achieve both stabilization of the fracture and rapid partial or complete pain relief. We prospectively evaluated the efficacy of VP in the relief of pain amongst those with insufficiency (osteoporotic) and pathologic fractures.

Methods & Materials

Patients with intractable pain from metastatic disease or osteoporotic fractures were treated with transpedicular injection of PMMA. All patients were assessed before and after the procedure utilizing the visual pain scale (VPS). Follow-up assessment consisted of a either a follow up appointment in the neurointerventional clinic or clinical visit with their primary care provider. Patients with recurrent back pain were followed in the pain management clinic.

Results

Three hundred patients (217 women, 83 men) seen at one institution for vertebral body fracture were evaluated. Their average age was 72 years (range 22 to 95 years). Two hundred seventy procedures were for insufficiency (osteoporotic) fractures and thirty procedures were for pathologic fractures. Pathologic fractures were determined based on positive imaging findings in the setting of malignancy and/or pathologic confirmation. All patients had an initial improvement in their pain symptoms while those patients with osteoporotic compression fractures had a greater improvement in their VPS score compared with those with pathologic fractures.

Conclusion

VP in osteoporotic and metastatic fractures improved patients' overall pain with a trend towards patients with osteoporotic fractures having a better response.

References/Financial Disclosures

1. Rollinghoff M, Zarghooni K, Schluter-Brust K, et al. Indications and contraindications for vertebroplasty and kyphoplasty. Arch Orthop Trauma Surg;130:765-774 2. Cheung G, Chow E, Holden L, et al. Percutaneous vertebroplasty in patients with intractable pain from osteoporotic or metastatic fractures: A prospective study using quality-of-life assessment. Can Assoc Radiol J 2006;57:13-21 3. Do HM. Percutaneous vertebroplasty: rationale, clinical outcomes, and future directions. Neuroimaging Clin N Am 2003;13:343-363