title: Midterm outcome after vertebroplasty: predictive value of technical and patient-related factors.
abstract: OBJECTIVE
  To evaluate different types of polymethylmethacrylate (PMMA) leakage and patient-related factors in relation to clinical midterm (1-24-month) outcome after vertebroplasty.
  
  
  METHODS
  Standardized four-view radiographs obtained during 363 vertebroplasties in 181 treatment sessions in 152 patients were reviewed (121 patients with osteoporotic fractures, 30 with malignant disease, and one with hemangioma). Four types of PMMA leakage and other potential predictors (patient age and sex, treated region, number of vertebral levels injected, preprocedural pain, PMMA volume per vertebra) were related to postprocedural pain response and midterm outcome after vertebroplasty. chi2 and Kruskal-Wallis tests were used for statistical analysis. The mean follow-up period was 8.8 months (range, 1-24 months).
  
  
  RESULTS
  At the time of discharge after the procedure, pain was absent after 106 of the 181 sessions (58.5%), better after 50 (27.6%), and the same after 25 (13.8%). In 258 of the 363 treated vertebral levels, at least one type of leakage was found. None of the evaluated factors were related significantly to postprocedural pain response, including PMMA leakage. Pain response at midterm outcome was strongly related to postprocedural treatment success, however (P <.001).
  
  
  CONCLUSIONS
  Small to moderate amounts of PMMA may escape from the vertebral body with no significant effect on therapeutic success. Immediate postprocedural pain relief is the best predictor of midterm clinical outcome after vertebroplasty.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University Medical Center, 510 S Kingshighway Blvd, St Louis, MO 63110-1076, USA.
authors.forename: Juerg
authors.initials: J
authors.lastname: Hodler
authors.forename: Dallas
authors.initials: D
authors.lastname: Peck
authors.forename: Louis A
authors.initials: LA
authors.lastname: Gilula
mesh_terms: D000368:Aged; D001416:Back Pain / Q000453:epidemiology / Q000209:etiology*; D001843:Bone Cements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000150:complications; D010147:Pain Measurement; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications / Q000453:epidemiology*; D016103:Spinal Fractures / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate