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Response of Non-midline Pain to Percutaneous Vertebroplasty 2006

Interventional Spine

Jill E Gibson, MD, Non ASSR Member
Louis A Gilula, MD, ASSR Member
Thomas K Pilgram, PhD, Non ASSR Member

Scientific Paper

Purpose

Several authors maintain that the ideal candidate for vertebroplasty has focal non-radiating back pain [1-6]. We could not find data regarding the frequency of non-midline pain in patients who were candidates for vertebroplasty and the effect of vertebroplasty in those patients. The purpose of this study was to determine the prevalence of non-midline symptoms in patients undergoing percutaneous vertebroplasty, and the response of these symptoms to vertebroplasty.

Methods & Materials

This is a retrospective study performed through examination of patient records, baseline questionnaires, demographic sheets, follow-up questionnaires, reports from phone follow-up, and pain location diagrams completed before and after the procedure. Institutional review board approval was obtained prior to starting this study. Data was used from 350 patient encounters, 686 vertebroplasties, and 288 patients. After determining the prevalence of non-midline pain, analysis of acquired data was performed to determine the efficacy of vertebroplasty in relieving non-midline pain.

Results

Non-midline pain was present in 240 of 350 (69%) patient encounters, with complete follow-up information in 206/240 (86%) of those procedures. Major non-midline symptom areas were ribs, hip/groin/buttocks, and legs/thighs. Lesser areas of non-midline symptoms were abdomen, shoulders, and waistline. Overall there was complete or partial improvement in non-midline pain in approximately 88% of thoracic, 84% of thoracolumbar, and 79% of lumbar areas or overall in about 83% of procedures. Treatments of the thoracic spine were somewhat more successful than treatments of the lumbar spine (92% vs. 76%; chi-square, p=0.02). Pain relief did not vary with region of pain at a statistically significant level.

Conclusion

Most patients presenting for percutaneous vertebroplasty have non-midline pain. Vertebroplasty reduced or eliminated non-midline pain in 76-92% of the cases in which it was reported. Procedures involving lumbar vertebra tended to be successful less often than others in relieving non-midline pain, but even in these cases the procedure was successful in approximately three quarters of the cases.

Comment: This work has not been previously presented in a meeting and is not published to date.

References

1. Dousset V, Mousselard H, de Monck d'User L, et al. Asymptomatic cervical haemangioma treated by percutaneous vertebroplasty. Neuroradiology 1996;38:392-394
2. Watts NB, Harris ST, Genant HK. Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty. Osteoporos Int 2001;12:429-437
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4. Ng PP, Caragine LP, Jr., Dowd CF. Percutaneous vertebroplasty: an emerging therapy for vertebral compression fractures. Semin Neurol 2002;22:149-156
5. Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 2000;39:1410-1414.
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