title: Lack of preoperative spinous process tenderness does not affect clinical success of percutaneous vertebroplasty.
abstract: OBJECTIVE
  Some operators use the lack of point tenderness over compression fractures to exclude patients from undergoing percutaneous vertebroplasty procedures. The purpose of this study was to determine whether this lack of tenderness portends a poorer clinical outcome after vertebroplasty than is achieved in patients with such tenderness.
  
  
  METHODS
  The authors conducted a retrospective review of consecutive percutaneous vertebroplasty procedures performed at their institution to define two populations. Group 1 included 90 patients with tenderness to palpation over the spinous process of the fractured vertebra, whereas group 2 included 10 patients without such tenderness. This second group presented with back pain and demonstrated tenderness distant from the fracture (n = 5), tenderness lateral to the fracture (n = 4), or no focal tenderness at all (n = 1). All were treated because of edema seen on magnetic resonance (MR) imaging and/or increased activity on bone scan. Clinical outcomes were assessed by quantitative measurements of pre- and postoperative levels of pain (11-point scale) and mobility (five-point scale).
  
  
  RESULTS
  Pain improvement of three points or greater occurred in 77 of the 85 patients (91%) in group 1 who complied with follow-up and nine of nine such patients (100%) in group 2, with mean postoperative pain levels of 1.82 and 0.33 points, respectively (P =.14). Forty of 45 patients (89%) in group 1 with impaired preoperative mobility reported improvement postoperatively, as did two of three such patients (67%) in group 2. Mean levels of postoperative impaired mobility for groups 1 and 2 were 0.27 and 0.67 points, respectively (P =.27).
  
  
  CONCLUSIONS
  Pain on palpation over the fractured vertebra is not a necessary requirement in selecting patients who will benefit from percutaneous vertebroplasty. Other factors, such as MR evidence of edema or increased uptake on bone scan, should be weighed considerably in the decision to treat a patient.
authors.affiliation: Department of Radiology, Box 800170, University of Virginia Health Services, Charlottesville, Virginia 22908, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Gaughen
authors.forename: Mary E
authors.initials: ME
authors.lastname: Jensen
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Schweickert
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Kaufmann
authors.forename: William F
authors.initials: WF
authors.lastname: Marx
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
mesh_terms: D000368:Aged; D001416:Back Pain / Q000503:physiopathology*; D001843:Bone Cements / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011300:Preoperative Care; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
chemical_list: D001843:Bone Cements