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The impact of vertebroplasty on pain and early rehabilitation after osteoporotic fractures 2005

Interventional Spine

Guido C Robotti, MD
Alain R Mayer , MD, Non ASSR Member
Remigio Depaoli , MD, Non ASSR Member
Duccio Boscherini , MD, Non ASSR Member
Silvia Tschuor , MD, Non ASSR Member

Purpose

Early mobilisation after fractures is very important for elderly people. It has been established that vertebroplasty has good results in pain relief and in bone strengthening. The aim of this study was to examine the impact of vertebroplasty on pain and mobility after vertebral fractures.

Methods & Materials

40 patients ( 33 f. and 7 m., aged 53 - 92 years) with osteoporotic vertebral fractures underwent vertebroplasty. The fracture level chosen for this study was between Th. 11 and L4.
Vertebroplasty was performed using a unilateral transpedicular approach with an eleven gauge needle after local anestesia and injection of polymethylmethacrilate. Major vertebral canal stenosis was an exclusion criteria. The procedure was performed under fluoroscopic control (Politron Angio Top). After the procedure a Multislice CT scan (Somatom Sensation 16, Siemens, Erlangen, Germany) was performed.
Pain improvement was recorded using a score from 1 to 10 immediately before and at 6 and 24 hours after treatment. There was a clinical follow-up of patients after 1 month.

Results

Pain before treatment was stated as 7.7 points on the average. Pain improvement after 6 hours was seen in all patients except 5 with a median improvement of 2.3 points. 2 patients reported worsening of pain by 1 point and the other 3 remained stable. After 24 hours 36 out of 40 patients experienced pain improvement by 3.1 points compared to baseline. 2 patients had their pain worsening unchanged by 1 point. 2 patients did not report any change in pain after their treatment.
On follow-up one of the 2 patients with pain worsening reported a slight decrease of pain after one week. The other patient still felt that the treatment had worsened his symptoms.
During this study we had two patients with complications: One patient experienced pain relief in the lumbar area but had L3 nerve root irritation on the right side for 5 days. Another patient had slight cement entry into the spinal canal seen on CT. The patient did not experience neurological symptoms at any time.
All patients could be mobilized early after treatment and no major complication was seen.
No correlation could be seen between amount of cement injected and degree of pain relief.

Conclusion

Vertebroplasty is a safe and very efficient method to treat pain in vertebral fractures. Significant pain relief is usually seen within 24 hours with early mobilization and discharge being possible in almost all patients.